Timing and value of protocol biopsies in well-matched kidney transplant recipients--a clinical and histopathologic analysis.
The role and timing of protocol biopsies after kidney transplantation are controversial. We changed our protocol biopsy policy and compared the predictive value of biopsies at different time-points. Protocol biopsies at 6 months (n = 45) were obtained during 2001-2004, and at 3 and 12 months from 2004 (n = 41). Donor biopsy was available from 70 patients. Histopathologic changes were described with chronic allograft damage index (CADI) and Banff 1997. Follow-up was for 18 months. Chronic allograft nephropathy (CAN) was present in 12%, 51%, and 34% and borderline or subclinical rejection in 9.8%, 8.9%, and 7.3% of patients at 3, 6, and 12 months. CAN at 6 and 12 months was associated with reduced graft function (P = 0.001). Semiquantitative CADI scores at all time-points significantly correlated with glomerular filtration rate (GFR) at 18 months. Strongest correlation existed with CADI at 12 months (P < 0.001). Change in CADI between 0-6 and 0-12 months, but not between 0-3 and 3-12 months, correlated with GFR at 18 months (P = 0.03, P = 0.01). Subclinical rejections were rare and chronic changes mild at 3 months. In our well-matched population, the predictive value of a biopsy at 3 months was inferior to biopsies at 6 or 12 months, both of which were effective in predicting long-term graft function.
Helanterä
Ilkka
I
Department of Medicine, Division of Nephrology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. ilkka.helantera@helsinki.fi
Ortiz
Fernanda
F
Helin
Heikki
H
Räisänen-Sokolowski
Anne
A
Honkanen
Eero
E
Koskinen
Petri
P
D000328:Adult; D001706:Biopsy; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000175:diagnosis; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007674:Kidney Diseases / Q000175:diagnosis; D016030:Kidney Transplantation / Q000009:adverse effects; D008875:Middle Aged; D013997:Time Factors; D014184:Transplantation, Homologous