title: Do protocol transplant biopsies improve kidney transplant outcomes?
abstract: OBJECTIVE
  The research undertaken on 'protocol' renal transplant biopsies has provided a rich, if not the richest, approach to better understanding of the immune and nonimmune impacts upon the transplant. The purpose of this review is to detail how the direct benefit to the patient also lies in these renamed 'surveillance' biopsies.
  
  
  RESULTS
  Undertaken at fixed time points after transplantation, biopsy provides individual diagnoses with which the clinician can vary immunosuppression both in intensity and in the type of agent used to modify pathological processes early in their course. Initial nonfunction from acute tubular necrosis, subclinical cellular and humoral rejection, calcineurin inhibitor nephrotoxicity, BK virus nephropathy and recurrent glomerulonephritis are all important diagnoses for which early intervention provides better therapeutic outcomes than delaying until they are clinically evident.
  
  
  CONCLUSIONS
  This review provides the recent evidence that has convinced many transplant units to embark upon surveillance programmes for their patients in order to individualize their immunosuppression and thus gain better outcomes.
authors.affiliation: Department of Renal Medicine, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia. Jeremy_chapman@wsahs.nsw.gov.au
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
mesh_terms: D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D002985:Clinical Protocols; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology* / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007668:Kidney / Q000187:drug effects / Q000276:immunology / Q000473:pathology*; D007674:Kidney Diseases / Q000276:immunology / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D011183:Postoperative Complications / Q000276:immunology / Q000473:pathology*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents