title: Clinical significance of an early protocol biopsy in living-donor renal transplantation: ten-year experience at a single center.
abstract: We report here our 10-year experience of a biopsy performed at day 14 after transplantation in 304 patients with stable graft function. The factors that may have influenced subclinical rejection were analyzed according to histology. The incidence of subclinical rejection was 13.2%. Addition of mycophenolate mofetile (MMF) as a primary immunosuppressant significantly decreased the incidence of subclinical rejection compared with patients without such treatment (odds ratio, 0.23; p < 0.05). On the other hand, HLA-DR antigen mismatch (odds ratio, 2.39) and unrelated donor (odds ratio, 2.10) were also significantly associated with decreased subclinical rejection (p < 0.05). The incidence of acute rejection in patients with normal findings was lower than in those with borderline changes or subclinical rejection (0.23 +/- 0.05 vs. 0.48 +/- 0.07 and 0.60 +/- 0.11, respectively; p < 0.05). The graft survival rates in patients with subclinical rejection were lower than in patients with normal or borderline changes at 1 (88.4% vs. 97.9% and 99.1%; p < 0.05), 5 (77.8% vs. 96.2% and 95.9%; p < 0.05) and 10 (62.3% vs. 96.2% and 93.7%; p < 0.05) years. Thus, a protocol biopsy performed on day 14 after transplantation is useful for predicting graft survival. Triple therapy including MMF, related donor and HLA-DR antigen match are important factors for reducing subclinical rejection in living-donor renal transplantation.
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul.
authors.forename: Bum Soon
authors.initials: BS
authors.lastname: Choi
authors.forename: Mi Jung
authors.initials: MJ
authors.lastname: Shin
authors.forename: Suk Joon
authors.initials: SJ
authors.lastname: Shin
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Yeong Jin
authors.initials: YJ
authors.lastname: Choi
authors.forename: Yong-Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: In Sung
authors.initials: IS
authors.lastname: Moon
authors.forename: Suk Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Yong Bok
authors.initials: YB
authors.lastname: Koh
authors.forename: Byung Kee
authors.initials: BK
authors.lastname: Bang
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
mesh_terms: D000208:Acute Disease; D000328:Adult; D001707:Biopsy, Needle; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000473:pathology*; D006085:Graft Survival; D006684:HLA-DR Antigens / Q000378:metabolism; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors
chemical_list: D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid