Due to a lack of consensus on SB for pediatric kidney transplant recipients, we evaluated the yield and clinical utility of SB findings at various time points post-transplant.
Patients transplanted at a single institution between 2014 and 2020 with at least one SB at 1.5, 3, 6, 12, and 24 months post-transplant were included. Additional biopsies were done for indication (IB). TCMR was classified by Banff criteria (score ≥i1t1).
Forty-seven patients had 142 biopsies (SBÂ =Â 113, IBÂ =Â 29); 19 (40.4%) of whom experienced at least one TCMR episode in the first-year post-transplant. The greatest SB yield of any pathologic abnormality was at 6Â months (57.1%; PÂ <Â .001). Six months also had the highest yield for TCMR (42.9%), compared with 3.3%, 20.8%, 15.0%, and 9.1% at 1.5, 3, 12Â months, and 24Â months, respectively (PÂ =Â .003). SB instigated intensification of immunosuppression (28.3% cases), reduction of immunosuppression (2.7% cases), and other non-immunosuppressant changes (1.8% cases). The 6-month SB led to the greatest number of changes in management (53.6%), compared with 1.5, 3, 12, and 24Â months (13.3, 20.8, 25.0, and 36.4%, respectively; PÂ =Â .012). There were no major biopsy-related complications.
SBs identify an important burden of subclinical rejection and other pathology leading to changes in clinical management. The greatest yield was at 6Â months, whereas the least utility was at the 1.5Â months. Selection of SB timing may be tailored such that the optimal yield is balanced against the procedural risk.
© 2020 Wiley Periodicals LLC.
About The Expert
Adina Landsberg
Maziar Riazy
Tom D Blydt-Hansen
References
PubMed
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