S JAHAN1, E SCHOFIELD1, R FAULL1
1Royal Adelaide Hospital, Adelaide, Australia
Aim: Early protocol biopsies are widely used in kidney transplantation, but the risk of complications must be weighed against potential benefit. In this study, we evaluated the diagnostic yield of early protocol biopsies.
Background: CHARTS’ unit policy recommends early (first 2-3 weeks) biopsy of kidney transplant recipients irrespective of clinical course. In many cases, the biopsy is for clinical suspicion of rejection (rising creatinine without other explanation), or during extended delayed graft function, where excluding rejection as a cause is not otherwise possible.
Methods: Single centre retrospective analysis of all early biopsies (<1 month) in patients receiving kidney alone transplantation from 2018 to mid-2020. Indications for biopsies were (1) clinical suspicion of rejection, (2) extended delayed graft function or (3) satisfactory clinical course (i.e. renal function stabilises at acceptable level, “Protocol biopsy”).
Results: A total of 193 kidney transplants were performed. There were 43 biopsies for clinical suspicion of rejection, of which 9 showed rejection. 69 biopsies were done for extended delayed graft function, of which 12 showed rejection. 82 patients had a protocol biopsy with satisfactory clinical course, yielding 7 patients with borderline to mild rejection. Of these, only 1 was considered clinically significant requiring treatment and this was in a high immunologically sensitised recipient. No major complications were recorded.
Conclusions: In our experience, protocol biopsies done following satisfactory clinical course have very low yield for clinically significant rejection, expect possibly in immunologically high risk transplants.
Sadia Jahan is a young enthusiastic nephrology trainee with great interest in Transplantation and its associated art. She graduated from University College London UK and has since worked in UK and numerous states in Australia gaining knowledge and experience along the way. She wants to make a difference in the Nephrology world and looks forward to achieving this when she is older and wiser with guidance from some distinguished mentors.