Determining the Utility of Protocol Biopsies in Kidney Transplant Recipients
1Virginia Commonwealth University, Falls Church
2Inova Fairfax Hospital, Falls Church.
Meeting: 2018 American Transplant Congress
Abstract number: D195
Keywords: Protocol biopsy, Rejection
Session Information
Session Name: Poster Session D: Kidney: Acute Cellular Rejection
Session Type: Poster Session
Date: Tuesday, June 5, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Protocol biopsies may allow for early detection and treatment of kidney transplant rejection or other correctable pathology, leading to improved graft survival. Unfortunately, biopsies may pose risks to healthy kidneys. To evaluate whether protocol biopsies are warranted in clinical settings, interim results are presented from 249 protocol biopsies performed on 119 patients at a single institution. Medical records from July 2011-July 2016 were reviewed to assess for rejection, as defined by Banff criteria, detected from protocol biopsies performed at 3 months, then yearly up to 5 years following kidney transplantation,
| Time | n (%) |
| 90 day | 83 (33.3) |
| 1 year | 71 (28.5) |
| 2 year | 54 (21.7) |
| 3 year | 35 (14.1) |
| 4 year | 5 (2.0) |
| 5 year | 1 (0.4) |
as well as biopsy-related complications within 2 weeks.
| Complication | n (%) |
| Arteriovenous Fistula | 6 (2.4) |
| Hematoma | 4 (1.6) |
| Hospitalization within 24 hrs | 3 (1.2) |
| Bleeding | 2 (0.8) |
| Hematuria | 2 (0.8) |
| Transfusion | 1 (0.4) |
| Damage to Nearby Structure | 1 (0.4) |
| Bradycardia | 1 (0.4) |
| Multiple complications | 4 (1.6) |
| Graft Loss | 0 (0.0) |
Data were analyzed per biopsy and for-cause biopsies were excluded. Of the 249 protocol biopsies, 38 (15.3%) demonstrated some form of rejection. Overall, 25 (10.0%) demonstrated borderline rejection only and 13 (5.2%) demonstrated other forms of rejection including acute cell-mediated rejection, antibody-mediated rejection, chronic rejection, or a combination of these. Biopsy-related complications were found in 16 biopsies (6.4%). No graft loss was identified. Treatment of borderline rejection remains controversial; however, there is a benefit to detecting treatable findings. Comparing the complication frequency (6.4%) to the frequency of detected treatable findings (5.2%) helps gauge risks and benefits of protocol biopsies. Protocol biopsies may be beneficial as complications are minor and findings may improve graft survival. New plasma-free DNA tests may accurately predict pathology without the need for protocol biopsies, but further studies are needed. Future results from the cohort of approximately 850 biopsies may provide greater insight regarding risks and benefits of performing protocol biopsies.
CITATION INFORMATION: Patel J., Heshmati K., Rogers A., Wali R., Jonsson J., Liu C., Emery E., Collins D., Karzai S., Piper J. Determining the Utility of Protocol Biopsies in Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Patel J, Heshmati K, Rogers A, Wali R, Jonsson J, Liu C, Emery E, Collins D, Karzai S, Piper J. Determining the Utility of Protocol Biopsies in Kidney Transplant Recipients [abstract]. https://atcmeetingabstracts.com/abstract/determining-the-utility-of-protocol-biopsies-in-kidney-transplant-recipients/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress