title: Kidney allograft surveillance biopsy practices across US transplant centers: A UNOS survey.
abstract: The approach to the diagnosis and management of subclinical rejection (SCR) in kidney transplant recipients remains controversial.
  
  
  
  We conducted a survey through UNOS across US transplant centers regarding their approach to surveillance biopsies and reasons for the nonperformance of surveillance biopsies.
  
  
  
  Responses were obtained from 106/238 centers (45%), and only 18 (17%) of the centers performed surveillance biopsies on all patients and 22 (21%) performed biopsy for select cases. The most common time points for surveillance biopsies were 3 and 12  months post-transplant. The common reasons for not performing biopsies were low yield (n = 44, 65%) and the belief that it will not change outcome (n = 24, 36%). The incidence of SC-TCMR was ≥ 10% among 39% of centers. The mean serum creatinine was slightly worse by 0.06 mg/dL at 1 year and 0.07 mg/dL at 3 years among centers performing biopsy, P < .0001. The. 1-and 3-year Observed-Expected (O-E) graft survival was similar among centers performing biopsies vs. those not performing biopsy (P = .07, .88).
  
  
  
  Only 17% of US centers perform surveillance biopsies, with another 21% performing surveillance biopsies in select cases (among centers that responded to the survey). Greater uniformity in the approach and management of this condition is of paramount importance.
authors.affiliation: Division of Renal and Electrolytes and Division of Transplant Surgery, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Rajil
authors.identifier: 0000-0002-3770-8446
authors.initials: R
authors.lastname: Mehta
authors.affiliation: United Network of Organ Sharing, Richmond, VA, USA.
authors.forename: Wida
authors.initials: W
authors.lastname: Cherikh
authors.affiliation: Division of Renal and Electrolytes and Division of Transplant Surgery, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Puneet
authors.initials: P
authors.lastname: Sood
authors.affiliation: Division of Renal and Electrolytes and Division of Transplant Surgery, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Sundaram
authors.initials: S
authors.lastname: Hariharan
mesh_terms: D064591:Allografts; D001706:Biopsy; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007157:Immunologic Surveillance; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012307:Risk Factors
keywords: T-cell mediated rejection (TCMR); graft survival; protocol biopsy; rejection; subclinical