Introduction and Methods:
Following transplantation, renal allograft biopsies are performed for all eligible kidney transplant recipients of The Lehigh Valley Transplant Center to assess renal allograft function. Biopsies are performed if transplant function declines or as a protocol at one, six or twelve months post-transplant. Pathological interpretation of the renal biopsy can reveal cellular or antibody-mediated rejection, calcineurin inhibitor toxicity, polyoma virus infections, and a variety of other abnormalities. Protocol biopsies facilitate the detection of potentially harmful abnormalities in an otherwise normally functioning kidney and allow for the initiation of intervention. With protocol biopsies in place, intervention can begin earlier than if a deterioration of renal function was the sole indicator for a biopsy. A study of biopsies for kidney recipients of The Transplant Center of the Lehigh Valley was conducted to investigate the usefulness of protocol biopsies.
Between January 2010 and June 2012, 125 kidney transplant recipients were transplanted through The Transplant Center of the Lehigh Valley and have at least one renal biopsy post-transplant recorded in Organ Transplant Tracking Record (OTTR). 318 total biopsies were reported for the 125 patients studied. Date of transplant, reason for biopsies, resulting diagnoses, and any intervention was noted for each patient. Descriptive statistics of the data was prepared and appropriate statistical tests were completed using MedCalc statistical software.
Symptomatic biopsies revealed abnormal findings on the biopsy that required intervention at approximately double the frequency of protocol biopsies. As expected, intervention was required following symptomatic biopsies at a higher frequency because the patient presented clinical symptoms indicating decreased renal function. Additionally, symptomatic biopsies have a noticeably larger variety of diagnoses and more severe diagnoses that require intervention.
Patients with delayed graft function (DGF) did not have a statistically significant difference in frequency of positive biopsy findings, rejection or requiring intervention as a result of a biopsy finding than patients who did not have DGF. Lastly, a positive 1 month protocol biopsy does not influence findings on the patient’s 6 month protocol biopsy and rejection diagnosis on a 1 month biopsy has no influence on whether a rejection diagnosis will be found as a result of the patient’s 6 month biopsy
The benefits of protocol biopsies greatly outweigh the small risk of complications, financial costs, patient discomfort, and inconvenience associated with protocol biopsies. Protocol biopsy findings allow for early, individualized intervention of subclinical graft dysfunction, improving graft outcomes.
Published In/Presented At
Fluck, V., Moritz, M., & Biondi, L. (2013, July 26). Effectiveness of Protocol Renal Allograft Biopsies: A 30 Month Retrospective Single Center Study. Poster presented at: Research Day 2013, Lehigh Valley Health Network, Allentown, PA.
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