Introduction:With the use of potent induction and maintenance immunosuppressive therapy, routine early/protocol biopsy in DGF patients is questionable.

AimThis study aimed to determine the incidence of biopsy proven rejection in kidney transplant recipients with DGF and to identify features that may predict the likelihood of rejection in this subgroup.

Methods:We retrospectively reviewed all the patients who experienced DGF and had a kidney biopsy within 10days from KT at our institution in the period between January1,2007 and October30,2017. DGF was defined as dialysis required within the first week post-transplant. Induction immunosuppression was variable and included Thymoglobulin/Campath/Simulect/none. Tacrolimus,mycophenolate and steroid comprised the maintenance immunosuppressive regimen. Our institutional practice called for an early allograft biopsy[within first 10days] during DGF to rule out superimposed rejection.

Results:Out of 167 KT recipients who experienced DGF in the study period, 40 were biopsied within the first 10days post-transplant. Of these 40patients, 4 had simultaneous kidney pancreas transplants and remaining 36 had isolated KT. For these 40 recipients, the mean age was 53, mean post-op biopsy date was 7, mean CIT was 12hrs. Blacks comprised 67.5%[27], whites 30%[12] and hispanics 2.5%[1]. Only 5 patients (12.5%) had biopsy-proven rejection (3 acute cellular rejection[ACR]≥Banff 1-A, 1 antibody mediated rejection [AMR] and 1 borderline ACR). Of the 3 KT recipients with ACR,2 received simulect on induction and the third recipient completed only one dose of thymoglobulin induction due to ARDS. The recipient with AMR had a positive B-cell crossmatch with +ve DSA and received eculiximab for induction. The KT recipient with borderline rejection received Simulect on induction. There was no evidence of rejection in any of the patients who received appropriate dose of Thymoglobulin/Campath on induction and had a negative cross match.

Conclusions:Currently, with the use of potent induction and maintenance immunosuppressive therapy, the incidence of biopsy proven rejection during DGF is minimal. We donot recommend protocol driven early biopsy in patients who were induced with Thymoglobulin/Campath and had a negative cross match. Literature reports biopsy related major complications as high as 2.7% and minor complications upto 17% in post KT patients. We favor an individualized approach towards biopsy of KT recipients with early DGF.

CITATION INFORMATION: Vijay A., Barrison L., Cooper M., Ghasemian S. Early Allograft Biopsy in Kidney Transplant Recipients with DGF – Call for an Individualized Approach Am J Transplant. 2017;17 (suppl 3).

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