Protocol Transplant Biopsies in Kidney Allografts

Racusen, Lorraine C.

doi:10.2215/cjn.01010905

Cited by 37 publications

(27 citation statements)

References 19 publications

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“…As suggested by these two papers as well as by Rush and colleagues (10), it is reasonable to only select patients at increased immunological risk (sensitized patients, patients with prolonged DGF, patients under high doses of CNI or with episodes of CNI toxicity. The day 0 biopsy remains highly informative in any case to obtain information about any preexisting lesions or rare unsuspected donor diseases (11). The last point, which is difficult to assess but is evident in our daily clinical practice, is that not only will biopsy samples always remain very informative sources for further fundamental studies for many groups, but they are also an extraordinary means of making progress in the comparison of pathology and clinical data.…”

Section: Brouard Et Almentioning

confidence: 99%

Revisiting the Natural History of IF/TA in Renal Transplantation

Brouard

Renaudin

Soulillou

2011

American Journal of Transplantation

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Despite the decrease in incidence of early clinical and subclinical rejection and increased 1-year graft survival in renal transplant patients, the rate of graft loss after the first year has been only moderately improved. Protocol biopsies obtained in the first year have shown rapid increase in the prevalence of IF/TA. This finding has been correlated with later allograft dysfunction and loss, mostly in cases of concomitant interstitial inflammation and fibrosis (1). The landmark study by Nankivell et al., performed in recipients of organs from deceased young donors under early cysclosporinbased immunosuppression, suggested two distinct phases of injury involved in IF/TA: an early tubulointerstitial damage from ischemic injury and allograft rejection and, beyond 1 year, microvascular, glomerular and additional tubulo interstitial injury interpreted as secondary CsA toxicity (2). Since this publication, chronic antibody-mediated rejection has been better identified as leading causes of late graft dysfunction. Moreover, a recent study showed that most cases of kidney graft loss have an identifiable cause that is not idiopathic IF/TA or CNI toxicity and that alloimmunity remains the most common mechanism leading to failure (3). Thus, with the current immunosuppressive regimens and the input of molecular phenotyping, one may question the natural history of IF/TA.

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Section: Brouard Et Almentioning

confidence: 99%

Revisiting the Natural History of IF/TA in Renal Transplantation

Brouard

Renaudin

Soulillou

2011

American Journal of Transplantation

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“…However, it may be an important tool to assess toxicity of calcineurin inhibitors as suggested by Racusen. [17] Ekberg, et al ,[18] had recently reported that recipients on low-dose tacrolimus have better graft function as compared to standard dose cyclosporine and low-dose cyclosporine and sirolimus. Thus, protocol biopsy may be required to assess the best possible dose of tacrolimus without compromising graft function.…”

Section: Discussionmentioning

confidence: 99%

The short-term impact of protocol biopsies in a live-related renal transplant program using tacrolimus based immunosuppression

et al. 2013

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The aim of the study was to assess the impact of protocol biopsies in a live-related renal transplant program using tacrolimus-based immunosuppression in the short term. Eighty-three live-related transplant recipients were randomly allocated to protocol biopsy group (Group I, n = 40) and a control group (Group II, n = 43). Other immunosuppressants in these groups consisted of either mycophenolate mofetil or azathioprine and steroids. Protocol biopsies were conducted in biopsy group at 1, 6, and 12 months post-transplant. The non-biopsy group was followed by serial serum creatinine and biopsies in them were conducted as and when clinically indicated. Both groups were analyzed at 12 months with respect to graft function and survival. The two groups were similar with respect to age, number of dialysis pre-operatively, tacrolimus levels, induction therapy, donor age, and donor glomerular filtration rate. Forty protocol biopsies were conducted at 1 month, 31 at 6 months, and 26 at 12 months. The prevalence of sub-clinical rejection at 1, 6, and 12 months in these biopsies was 17.5%, 11.2%, and 10.3%, respectively. The prevalence of calcineurin inhibitor toxicity during same period was 15%, 15.5%, and 14.4%, respectively. The cumulative rejection rate in Group I and Group II at 12-month follow-up was 10.3% and 11.3% (P = 0.78), respectively, and cumulative calcineurin inhibitor toxicity at 12 months was 14.4% and 9.3% (P = 0.59), respectively, were not statistically significant. There was no difference in graft survival and function at 1 year. Protocol biopsies have a limited role in a well-matched renal transplant program with tacrolimus-based immunosuppression in the short term. However, the long-term impact of protocol biopsies needs further evaluation.

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“…Although the incidence of complications after a percutaneous renal biopsy has decreased with the use of smaller gauge biopsy needles, biopty devices and ultrasound guidance,[12] biopsy procedures of renal allografts are known to have a higher incidence of gross hematuria, hematoma formation, hemoperitoneum and arteriovenous fistulae. [34] While minor complications generally resolve spontaneously, major complications like acute renal obstruction, arteriovenous fistula, abscess formation and septicemia require further treatment, sometimes even evacuation of the hematoma or nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

An unusual case of abdominal wall bleeding after renal allograft biopsy

et al. 2011

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We report an unusual case of a enlarging anterior abdominal wall hematoma after percutaneous biopsy of a renal allograft. Angiography-directed embolization of the vessels filling the pseudoaneurysm was done and followed up with surgical exploration of the hematoma. In order to avoid this complication, Color Doppler evaluation of the overlying abdominal wall is suggested to look for significant vessels before the biopsy procedure.

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Protocol Transplant Biopsies in Kidney Allografts

Cited by 37 publications

References 19 publications

Revisiting the Natural History of IF/TA in Renal Transplantation

Revisiting the Natural History of IF/TA in Renal Transplantation

The short-term impact of protocol biopsies in a live-related renal transplant program using tacrolimus based immunosuppression

An unusual case of abdominal wall bleeding after renal allograft biopsy

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