Data on protocol biopsies in childhood are rare. We evaluated renal function in 86 children after kidney transplantation (KTX) who underwent a protocol biopsy 6 months after transplantation. The patients were divided into three groups: group 1: protocol biopsy showed no pathological findings and no intervention was necessary, (n=44), group 2: pathological findings were found in the protocol biopsy and intervention was performed because of stable serum creatinine (n=27), group 3 pathological findings according to the BANFF-classification were documented. Intervention was started because of serum creatinine increase of >20% (n = 15).

The glomerular filtration rate (GFR) was evaluated at time of biopsy and 6, 12 and 24 months after biopsy and delta GFR was determined. Differences were testes for significance by Man-Whitney-U-Test.

Children from group 1 presented with a GFR of 79 (± 23) ml/min/1.37 m² BSA that decreased after 6, 12 and 24 months to 75 (± 24), 74 (± 25) and 64 (± 23) ml/min/1.73 m² BSA. In group 2, GFR changed from a mean of 83 (± 26) to 83 (± 25), 79 (± 29) and 75 (± 27) ml/min/1.73 m² after 6, 12 and 24 months. Renal biopsy showed the following results: Borderline (n=19), BANFF Ia (n=6), BANFF >Ia (n=2). In group 3, GFR changed from 59 (± 23) to 68 (± 25), 64 (± 23) and 51 (± 12) ml/min/1.73 m² KOF in the same time frame. Renal biopsy showed the following results: Borderline (n=2), BANFF Ia (n=10), BANFF >Ia (n=3). After 6 months, deltaGFR in group 1 was -4.7, in group 2 -0.9 and in group 3 +9.1 ml/min/1.73 m[sup2] BSA (1 vs. 2 p= 0.434; 1 vs. 3 p=0.001; 2 vs. 3 p=0.010), after 12 months -6.5/-5.1/+4.5 ml/min/1.73m[sup2] BSA (p>0.05), after 24 months -15.3/-9.6/+2.2 ml/min/1,73 m[sup2] BSA (1 vs. 2 p=0.538, 1 vs. 3 p=0.009, 2 vs. 3 p=0.035).

In case of normal protocol biopsy in stable patients, course of GFR is independent of the biopsy results. Therefore, the concept of protocol biopsies 6 months after pediatric KTx is questionable. Intervention in case of a 6 months biopsy in patients with creatinine increases seems to improve future graft function.

CITATION INFORMATION: Pape L., Lerch C., Ahlenstiel-Grunow T., Bräsen J., Kanzelmeyer N. Influence of 6 Months Protocol Biopsies with and without Intervention on Course of GFR after Pediatric Renal Transplantation Am J Transplant. 2017;17 (suppl 3).

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