An Analysis of Early Renal Transplant Protocol Biopsies – the High Incidence of Subclinical Tubulitis

Shapiro, Ron; Randhawa, Parmjeet; Jordan, Mark L.; Scantlebury, Velma P.; Vivas, Carlos; Jain, Ashok; Corry, Robert J.; McCauley, Jerry; Johnston, James R.; Donaldson, Joseph; Gray, Edward A.; Dvorchik, Igor; Hakala, Thomas R.; Fung, John J.; Starzl, Thomas E.

doi:10.1034/j.1600-6143.2001.010109.x

Cited by 93 publications

(88 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No deaths were observed, and only one graft was lost; all complications presented within 4 h of biopsy (27). Similarly, of 277 renal biopsies that were performed in a single-center study, there was only one (0.4%) serious hemorrhagic complication (28). An additional study of 1171 protocol biopsies has reported rates of major complications of just 0.7% when a 16-gauge needle was used to perform the procedure and 1% when an 18-gauge needle was used (29).…”

Section: Safety Of Protocol Biopsiesmentioning

confidence: 91%

Protocol Transplant Biopsies

Wilkinson

2006

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Studies suggest that surveillance or protocol biopsies that are performed during the first year after kidney transplantation may be clinically useful in identifying early acute rejection or chronic allograft nephropathy at a point when they may be amenable to treatment. Although the benefit of this approach has yet to be evaluated in large, multicenter, prospective trials, numerous studies suggest that implementation of protocol biopsies may improve long-term graft function. In particular, a number of reports suggest that detection of chronic allograft nephropathy in early protocol biopsies is predictive of subsequent graft function and loss and that early treatment may have a dramatic effect on the outcome of the graft. Protocol biopsies also have the potential to be of great value in high-risk patients, such as those with delayed graft function, by allowing for early intervention for acute rejection. Furthermore, the procedure seems to be relatively straightforward and safe. Nevertheless, paucity of data has meant that clear proof of a benefit of early treatment of subclinical rejection and chronic allograft nephropathy detected by protocol biopsy is lacking. Moreover, the optimal timing of protocol biopsies and reliable methods to quantify the histologic changes observed in biopsy specimens have yet to be determined. This review discusses the pros and cons of protocol biopsies and considers the place of this procedure in the routine treatment of kidney transplant patients.

show abstract

Section: Safety Of Protocol Biopsiesmentioning

confidence: 91%

Protocol Transplant Biopsies

Wilkinson

2006

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…Our current definition of subclinical rejection requires that the serum creatinine be increased by Ͻ10% 2 wk before the protocol biopsy and that the histologic Banff score is "ai2at2" (type IA acute rejection) or greater. Numerous groups since have confirmed the occurrence of subclinical rejection as defined above, in both adults (7)(8)(9)(10)(11)(12)(13)(14) and children (15,16). Some investigators include "borderline" rejection (Banff score Ͻai2at2) in the subclinical rejection category (7,9 -11,14).…”

Section: Subclinical Rejection: Prevalence Risk Factors and Signifimentioning

confidence: 92%

“…More recent studies have reported on early subclinical rejection in patients who received tacrolimus, either with (10,11,13,21,22) or without (7) MMF. Jurewicz (7) reported a prevalence of subclinical rejection (that included "borderline") of 18% at 3 mo in patients who received kidneys from deceased donors and were treated with tacrolimus, azathioprine, and prednisone.…”

Section: Prevalence Of Subclinical Rejectionmentioning

confidence: 99%

Protocol Transplant Biopsies

Rush¹

2006

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

“…This discrepancy between clinical signs of renal failure and histologic findings of rejection confirms the finding in humans that renal allograft biopsies can diagnose subclinical rejection and are an important diagnostic tool for the follow up of renal transplants. 7,13,14,21,26,27 Although the Banff '97 classification was helpful for detecting a rejection, it did not reliably reflect the severity of the reaction. No significant differences were found in serum creatinine concentrations (used as measure for the severity of renal failure) in the different groups of the acute or active (P ϭ 0.942) or chronic (P ϭ 0.282) rejection reactions.…”

Section: Discussionmentioning

confidence: 99%

“…In feline renal transplants, the incidence of distinct tubulitis, in which individual lymphocytes are found in the tubular wall or lumen, is low and difficult to ascertain, whereas in the Banff '97 classification system, tubulitis is one of the principal indicators of an acute cellular rejection. 23,27 The severity of this tubular inflammation forms the basis for the differentiation between renal tubulointerstitial rejection and inflammation character- ized as borderline changes (KDARB). Therefore, in this system, many feline renal transplants with distinct interstitial inflammation attributed to acute cellular rejection were not classified as such.…”

Section: Discussionmentioning

confidence: 99%

Histopathologic Findings and Classification of Feline Renal Transplants

et al. 2004

View full text Add to dashboard Cite

Abstract. Seventy-seven feline transplant kidney specimens, obtained from 1 to 3,183 days (9 years) after transplantation, were reevaluated histologically and classified on the basis of the Banff '97 guidelines for human renal transplant kidneys. Overall, this classification system appeared useful in detecting rejection reactions and confirmed the finding in humans that biopsies can diagnose subclinical rejection and therefore are an important diagnostic tool for the follow up of renal transplants. However, on the basis of serum creatinine values, the severity of the acute or active and chronic lesions was not accurately reflected by this scoring system. This is thought to be due to the significant differences in histologic rejection patterns, especially in acute or active rejection, in cats when compared with humans. Tubulitis, lymphocytic glomerulitis, and vasculitis, which are the main pillars of the Banff '97 acute or active rejection scoring system, are either rare or not found in cats. The presence of significant necrotizing glomerulitis and vasculitis in feline renal transplants might imply that the rejection is complicated by acute antibody-mediated rejection. Alternatively, cyclosporine toxicity also should be considered because some of these kidneys show other signs of cyclosporine toxicity. Finally, the significance of subcapsular and interlobular phlebitis, rarely described in human rejection reactions but a distinct entity in cats, is unknown. From this study, it is clear that there are significant differences in the histology of acute or active rejection between humans and cats and that a better understanding of the histologic appearance of renal allografts will be especially beneficial for treatment and prognostic purposes.

show abstract

An Analysis of Early Renal Transplant Protocol Biopsies – the High Incidence of Subclinical Tubulitis

Cited by 93 publications

References 14 publications

Protocol Transplant Biopsies

Protocol Transplant Biopsies

Protocol Transplant Biopsies

Histopathologic Findings and Classification of Feline Renal Transplants

Contact Info

Product

Resources

About