J Korean Soc Transplant.  2011 Dec;25(4):264-269. 10.4285/jkstn.2011.25.4.264.

Clinical Significance of Protocol Biopsy Soon after Renal Transplantation

• Oh SY
• Min SI
• Ahn S
• Kim SM
• Park D
• Park T
• Moon KC
• Ha J
• Kim SJ

• KMID: 1450975
• DOI: http://doi.org/10.4285/jkstn.2011.25.4.264

Abstract

BACKGROUND
Several studies reported that sub-clinical rejection (SCR) detected by a protocol biopsy soon after renal transplantation does permanent damage to a renal allograft, contributing to chronic allograft nephropathy (CAN). This article investigated the risk factors involved in SCR and the effects of treating SCR, and evaluated the clinical significance of a protocol biopsy soon after renal transplantation.
METHODS
From January 2007 to June 2010, 253 patients received renal transplantation. Patients were divided into two groups according to whether or not they had undergone a protocol biopsy. To analyze the effect of SCR treatments, patients who were diagnosed with SCR were divided into two groups according to whether or not they had been treated with SCR. The patients who did not undertake a protocol biopsy were included in the untreated groups.
RESULTS
Among 138 patients who undertook protocol biopsies, 65 patients (47.1%) showed SCR. In univariate analysis, both the number of HLA-DR mismatches (P=0.003) and not using Simulect (P=0.01) were identified as risk factors of SCR. In multivariate analysis, not using Simulect (P=0.006) was identified as an risk factor independent of SCR. deltaGFR, subtracting GFR at 1 week from GFR at that point, showed significant differences between SCR-treated patients and untreated patients at 1, 3, 6, 9, 12, 24, and 36 months with a P value of less than 0.05.
CONCLUSIONS
A protocol biopsy can detect SCR, especially in patients with risk factors such as a high number of HLA mismatches or not using Simulect. Treatment of SCR detected by protocol biopsy will help to improve long-term renal function.

Keyword

Protocol biopsy; Subclinical rejection (SCR); Renal transplantation

MeSH Terms

Antibodies, Monoclonal
Biopsy
HLA-DR Antigens
Humans
Kidney Transplantation
Multivariate Analysis
Recombinant Fusion Proteins
Rejection (Psychology)
Risk Factors
Transplantation, Homologous
Antibodies, Monoclonal
HLA-DR Antigens
Recombinant Fusion Proteins

Figure

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  Fig. 1. Changes in mean MDRD GFR of each group. There were no significant differences between two groups in GFR after 3 months. *P＜0.05.

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  Fig. 2. δ GFR defines as a result of subtraction MDRD GFR at 1 wk from MDRD GFR at the point. There were significant differences between two groups in δ GFR at 1, 3, 6, 9, 12, 24 and 36 months. *P＜0.05.

Reference

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