Protocol Transplant Biopsies

Abstract

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.

Evaluation of Protocol Biopsy Utility 12 Months after Renal Transplantation: A Multicenter Observational Analysis

“…One year posttransplant is a time point commonly used for performing such biopsies. The aim is to detect subclinical rejection or nonimmunological injury, notably CNI-related nephrotoxicity, and to quantify IF/TA [11]. However, SB are inconvenient for patients, carry a risk for complications [12], and incur additional cost [11].…”

“…The aim is to detect subclinical rejection or nonimmunological injury, notably CNI-related nephrotoxicity, and to quantify IF/TA [11]. However, SB are inconvenient for patients, carry a risk for complications [12], and incur additional cost [11]. Furthermore, robust evidence to confirm a benefit for SB in terms of graft function or survival is lacking, as is agreement on the optimal timing and frequency of biopsies.…”

Transplanting Against Histocompatibility Barriers

“…The ability to detect and treat subclinical rejection at an early stage may have long term benefits on allograft survival [84,85]. Persistent donor specific antibodies has been linked to the development of transplant glomerulopathy [86,87].…”

Regulatory T Cells in the Immunodiagnosis and Outcome of Kidney Allograft Rejection

“…Many centers have introduced periodic biopsy surveillance protocols; however, to date, the clinical impact of a monitoring strategy based on biopsies is not clear [2, 3]. …”