Sequential and Long-Term Protocol Biopsy Is Useful for the Detection of Subclinical Lesions of Clinical Interest in Kidney Allografts.
1Department of Urology and Renal Transplantation Surgery, Sapporo Hokuyu Hospital, Sapporo, Japan
2Department of Pathology, Sapporo City General Hospital, Sapporo, Japan.
Meeting: 2016 American Transplant Congress
Abstract number: A237
Keywords: Glomerulonephritis, Graft failure, Polyma virus, Protocol biopsy
Session Information
Session Name: Poster Session A: Long Term Outcomes in Kidney Transplantation
Session Type: Poster Session
Date: Saturday, June 11, 2016
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
Objectives: Detection of subclinical lesions is important to overcome the obstacles to improve long-term graft survival after kidney transplantation. The aim of this study was to analyze the results of sequential protocol biopsy and elucidate the findings which are important for decision making.
Methods: 94 sequential kidney recipients more than 1y after transplant were included in the study. A total of 576 non-episodic protocol allograft biopsy was taken at 1, 3, 6m, 1, 2, 3 and 5y posttransplant. Specimens were reviewed by a single pathologist and each scores of the Banff criteria were analyzed. The presence of de novo donor-specific antibody (dnDSA) were also analyzed. Risk factors for the development of ci, aah and microvascular inflammation (MVI, g+ptc) lesions were analyzed using logistic regression analysis. The presence of lesions of clinical interest (LCI) such as rejection, viral infection, toxicity and recurrent diseases was also studied.
Results: t and i scores were detected most frequently at 3m to 1Y at low rates (9-18%). The frequency of ci score rapidly increased within 1y up to 60% and gradually thereafter. ct score was observed in more than 90% at 1y. The frequency of aah score rapidly increased after 3y. MVI was observed at a low rate constantly and 5y MVI-free graft survival was 84%, which was lower than dnDSA-free survival (90%), Emergence of dnDSA was frequently preceded by subclinical MVI. The only significant risk factors for the development of ci, aah and MVI were history of acute rejection, donor hypertension and the presence of pretransplant DSA, respectively. The frequency of LCI was around 25% up to 2y but increased to 50% by 5y. Specificallly, drug toxicity, MVI were the major lesions after 1y and recurrent disease and polyoma viral infection were observed less frequently.
Conclusions: Protocol biopsy is useful in detecting manageable subclinical lesions and decision making.
CITATION INFORMATION: Miura M, Higashiyama H, Tsuji T, Fukasawa Y. Sequential and Long-Term Protocol Biopsy Is Useful for the Detection of Subclinical Lesions of Clinical Interest in Kidney Allografts. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Miura M, Higashiyama H, Tsuji T, Fukasawa Y. Sequential and Long-Term Protocol Biopsy Is Useful for the Detection of Subclinical Lesions of Clinical Interest in Kidney Allografts. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/sequential-and-long-term-protocol-biopsy-is-useful-for-the-detection-of-subclinical-lesions-of-clinical-interest-in-kidney-allografts/. Accessed May 9, 2025.« Back to 2016 American Transplant Congress