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BackgroundKidney transplant rejection is a major cause of graft dysfunction and failure. In recent years, there has been increased interest in renal allograft protocol biopsies to allow earlier detection of acute or chronic graft dysfunction or rejection to improve long-term graft survival and reduce graft failure. This study aimed to determine if renal allograft protocol biopsies performed within the first 12 months after transplantation help detect subclinical graft dysfunction or rejection. MethodsWe performed a retrospective analysis utilizing SUNY Upstate University Hospital data from January 2016 to March 2022 to assess transplant outcomes and biopsies. The study population was divided into two subgroups: non-protocol biopsies and protocol biopsies within the 12 months post-transplant. ResultsA total of 332 patients met our inclusion criteria and were included in the study. Patients were divided into two subgroups: 135 patients (40.6%) in the protocol biopsy group and 197 patients (59.4%) with nonprotocol indication biopsies during the first year after the transplant. The overall number of rejection episodes reported was eight episodes (4.6%) in the protocol biopsy group and 56 episodes (18.3%) in the non-protocol indication biopsy group, which was significantly higher in the non-protocol biopsy group (P=0.001). Antibody-mediated rejection (ABMR) and T-cell-mediated rejection (TCMR) diagnoses were significantly higher in the non-protocol biopsy group (P=0.03 and P=0.03, respectively). We also mentioned a trend in terms of mixed antibody-mediated rejection and T-cell-mediated rejection diagnosis (P=0.07). One year after the rejection, the mean glomerular filtration rate (GFR) was 56.78 mL/min/1.73m 2 in the protocol biopsy group and 49.14 mL/min/1.73m 2 in the non-protocol indication biopsy group, and there was no significant difference anymore (P=0.11). The patient survival rate was not significantly higher in the protocol biopsy group compared to the non-protocol indication biopsy group (P=0.42). ConclusionThis study suggests that performing protocol biopsies does not significantly benefit rejection rates, graft survival, or renal function within the first 12 months post-transplant. Given these results and the small but non-zero risk of complications associated with protocol biopsies, they should be reserved for those patients at high risk of rejection. It may be more feasible and beneficial to utilize less invasive tests, such as DSA and dd-cfDNA testing, for early diagnosis of a rejection episode.

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Introduction Kidney transplantation (KT) is the gold standard treatment for end‐stage renal disease (ESRD) patients. Obesity is a strong risk factor for developing cardiovascular disease, chronic kidney disease, and ESRD. This study aimed to investigate the outcomes of kidney transplantation in obese recipients. Material and methods We retrospectively reviewed the medical records of recipients from January 2016 to December 2021 in a single center. Outcomes in recipients of a kidney allograft with BMI ≥ 30 were compared with the outcomes in recipients with 30 < BMI. Results A total of 467 consecutive kidney transplantation recipients’ files were studied. 213 (45.6%) allograft recipients had a BMI ≥ 30, and 254 (54.4%) allograft recipients had a BMI < 30. DGF rate was 29.1% in the BMI ≥ 30 and 30.7% in the BMI < 30 group (P = 0.41). On the other hand, 30 days readmission rate also did not show a significant difference between the BMI ≥ 30 and BMI < 30 allograft recipients (37 vs. 33.8%, P = 0.46). The mean overall costs of transplantation in the BMI ≥ 30 group was $254,395, and it was $256,029 in the BMI < 30 group (P = 0.84). Conclusion Our study shows that the outcomes of renal allograft transplant were comparable between recipients with BMI ≥ 30 and BMI < 30 in terms of DGF, LOS, 30 days readmission, acute rejection rate, and survival rates, and BMI should not be a single independent criterion for decision making to select an optimal recipient.