Highly sensitized kidney transplant recipients (hsKTR) are at an increased risk of antibody mediated rejection (AMR). Following implementation of the new kidney allocation system (KAS) which led to a significant increase in the number of transplants for this population, we performed protocol kidney biopsies (PKBx) and donor specific antibody testing to aid in the early recognition of antibody or cell-mediated rejection to achieve better graft function.

We compared the outcomes of kidney transplant recipients with a cPRA ≥ 90 who underwent PKBx and testing for donor specific antibodies after the new KAS with a historical control group transplanted before the new KAS who also had a cPRA ≥ 90 and did not receive PKBx. All patients had negative crossmatch at transplant, were induced with thymoglobulin and maintained on Tacrolimus, Mycophenolate Mofetil, and Prednisone. Protocol biopsies were performed at 1, 3 and 6 months. Estimated GFR (eGFR) using the MDRD equation was compared between the groups at 1, 3, 6, 12 and 24 months.

A total of 54 biopsies were performed. No inflammation or c4d deposition was noted in 42 (74.7%). 5 patients were treated for acute cellular rejections (9.25%) and 5 were treated for AMR (9.25%). 2 donors in the new KAS group had kidney donor profile indexes (KDPI) greater than 85. Mean KDPI was 38.55 in the biopsy group.

In this single center analysis, there was no difference in eGFR at 2 years after transplant in hsKTR undergoing protocol biopsies compared to the historical control group of hsKTR who did not undergo protocol biopsies. Further longer term follow up is necessary to determine the usefulness of protocol biopsies in improving graft function.

CITATION INFORMATION: Kuppachi S., Kalil R., Fraer M., Sanders M., Swee M., Stewart Z., Thomas C. Do Protocol Biopsies in the Highly Sensitized Improve Renal Allograft Survival? A Single Center Evaluation of 2 Year Graft Function Am J Transplant. 2017;17 (suppl 3).

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