Volume 20, Issue 11 pp. 982-990

Timing and value of protocol biopsies in well-matched kidney transplant recipients – a clinical and histopathologic analysis

Ilkka Helanterä

Ilkka Helanterä

Department of Medicine, Division of Nephrology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

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Fernanda Ortiz

Fernanda Ortiz

Department of Medicine, Division of Nephrology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

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Heikki Helin

Heikki Helin

Department of Pathology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

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Anne Räisänen-Sokolowski

Anne Räisänen-Sokolowski

Department of Pathology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

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Eero Honkanen

Eero Honkanen

Department of Medicine, Division of Nephrology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

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Petri Koskinen

Petri Koskinen

Department of Medicine, Division of Nephrology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

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First published: 17 August 2007
Citations: 10
Ilkka Helanterä MD, PhD, Department of Medicine, Division of Nephrology, Helsinki University Hospital, Kasarmikatu 11-13, PO Box 263, FIN-00029 HUS, Helsinki, Finland. Tel.: +358 9 47188203; fax: +358 9 47188400; e-mail: [email protected]

Summary

The role and timing of protocol biopsies after kidney transplantation are controversial. We changed our protocol biopsy policy and compared the predictive value of biopsies at different time-points. Protocol biopsies at 6 months (n = 45) were obtained during 2001–2004, and at 3 and 12 months from 2004 (n = 41). Donor biopsy was available from 70 patients. Histopathologic changes were described with chronic allograft damage index (CADI) and Banff 1997. Follow-up was for 18 months. Chronic allograft nephropathy (CAN) was present in 12%, 51%, and 34% and borderline or subclinical rejection in 9.8%, 8.9%, and 7.3% of patients at 3, 6, and 12 months. CAN at 6 and 12 months was associated with reduced graft function (P = 0.001). Semiquantitative CADI scores at all time-points significantly correlated with glomerular filtration rate (GFR) at 18 months. Strongest correlation existed with CADI at 12 months (P < 0.001). Change in CADI between 0–6 and 0–12 months, but not between 0–3 and 3–12 months, correlated with GFR at 18 months (P = 0.03, P = 0.01). Subclinical rejections were rare and chronic changes mild at 3 months. In our well-matched population, the predictive value of a biopsy at 3 months was inferior to biopsies at 6 or 12 months, both of which were effective in predicting long-term graft function.

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