The primary aim of this study was to in depth examine if the histological result of a transplanted kidney biopsy can predict the prognosis for the graft and the patient. The secondary aim was to extend knowledge of the impact of time elapsed on biopsy findings.
Data from 1462 patients were merged from a kidney transplantation registry and a biopsy registry during January 1, 2007 and September 30, 2017. Kaplan-Meier analysis and multivariate Cox-regression analysis were performed and Hazard Ratios (HR) with 95% Confidence Intervals (CI) were presented.
Compared to normal biopsy findings, graft survival after biopsy (gsaBiopsy) was shorter for patients with glomerular diseases (HR8.2, CI:3.2-21.1), rejections (HR4.2, CI:1.7-10.3), chronic changes including IFTA (HR3.2, CI:1.3-8.0), acute tubular injuries (HR3.0, CI:1.2-7.8), and borderline changes (HR2.9, CI:1.1-7.6). Sub-analysis of rejections showed shorter gsaBiopsy for chronic TCMR (HR4.7, CI:1.9-11.3), active ABMR (HR3.6, CI:1.7-7.7) and chronic ABMR (HR3.5, CI:2.0-6.0). Patients with TCMR Banff grade II (HR0.35, CI:0.20-0.63) and grade I (HR0.52, CI:0.29-0.93) had a better gsaBiopsy compared to all other types of rejections.
Shorter gsaBiopsy was noted in kidneys with glomerular diseases, rejections, acute tubular injuries and borderline changes. TCMR Banff rejections grade I and II were associated with a better prognosis.

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