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A Systematic Over View of Five Year Results of Serial Protocol Kidney Transplant Biopsies.

A. Geraedts, M. Tavakol, F. Vincenti, S. Chandran, Z. Laszik, B. Lee, J. Roberts, M. Sarwal.

Surgery, UCSF, San Francisco, CA.

Meeting: 2016 American Transplant Congress

Abstract number: 102

Keywords: Graft function, Inflammation, Kidney transplantation, Protocol biopsy

Session Information

Date: Sunday, June 12, 2016

Session Name: Concurrent Session: Delayed Graft Function and Protocol Biopsy

Session Time: 4:30pm-6:00pm

 Presentation Time: 5:30pm-5:42pm

Location: Room 302

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Background: Protocol biopsies can detect sub-clinical rejection. With declining rates of clinical acute rejection, a systematic review of protocol biopsies can provide clues about other subtle clinical and histological correlates of graft injury.

Methods: A single-center, retrospective analysis was conducted on all 6 month protocol renal TX biopsies performed between 2009- 2014, scored by Banff classification by a single pathologist. Data analysis was performed by correlation, regression and anova, with significant p values <0.05.

Results. 1975 patients were consecutively transplanted over the 5 year period; 1062 patients received 6 month protocol biopsies. The mean recipient age was 50±14.6 yrs; mean donor age was 37.5±14.7 yrs, with 37.4% living donors and a DGF rate of 19.9%. Immunosuppression was predominantly TAC/Steroids/MMF, with ATG (41.5%), Simulect (49.6%), Belatacept (2.9%) or Campath (0.18%) induction. TCMR was detected in 3.4% (36) and AHR in 0.4% (5) cases, though borderline changes were called n 8.7% (96). Blood BK-QPCR was positive in 22.8% (252), but BK nephritis was rare at 1.8% (18). Mild tubular atrophy was often seen (54%; 596), but substantive tubular atrophy (ct>2) was rarely seen (4.4%; 48). Mild inflammation (>i0) was seen in 13.4% (148) and some tubulitis could be noted even in non-atrophic areas (>t0) in 26.9% (297), without meeting Banff criteria for rejection. Peri-tubular capillaritis (ptc>0) was rare at 3.2% (35) and arteriolar hylanosis (ah>0) was seen in 16.9% (186). Patients with inflammation had no differences in mean age, DSA, PRA or NODAT, but significantly correlated with greater decline in GFR between 1 and 24 mo (coeff: 0.21 C.I.(0.2 – 0.43); p:0.03).Patients with tubulitis had higher rates of NODAT and DSA and a significant correlation with worse 2 yr GFR (coeff,0.42 C.I.(0.13 – 0.70); p:0.004), which persisted when corrected for age at tx,donor type and NODAT(coeff:0.53 C.I.(0.21 – 0.86); p:0.001). Drug toxicity (ah) had no impact on graft function.

Conclusions. Protocol biopsy data reveals that Banff confirmed sub-clinical rejection is a very low frequency finding, but even very mild changes of inflammation and tubulitis, currently not factored into Banff scoring for an independent rejection diagnosis, have a substantive impact on downstream graft function. Further analysis is underway to develop a composite protocol biopsy risk score that could be more informative for patient management.

CITATION INFORMATION: Geraedts A, Tavakol M, Vincenti F, Chandran S, Laszik Z, Lee B, Roberts J, Sarwal M. A Systematic Over View of Five Year Results of Serial Protocol Kidney Transplant Biopsies. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Geraedts A, Tavakol M, Vincenti F, Chandran S, Laszik Z, Lee B, Roberts J, Sarwal M. A Systematic Over View of Five Year Results of Serial Protocol Kidney Transplant Biopsies. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/a-systematic-over-view-of-five-year-results-of-serial-protocol-kidney-transplant-biopsies/. Accessed March 1, 2021.

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