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Kidney allograft surveillance biopsy practices across US transplant centers: A UNOS survey
Author(s) -
Mehta Rajil,
Cherikh Wida,
Sood Puneet,
Hariharan Sundaram
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12945
Subject(s) - medicine , biopsy , subclinical infection , incidence (geometry) , urology , creatinine , kidney transplant , kidney , kidney transplantation , transplantation , surgery , physics , optics
Background The approach to the diagnosis and management of subclinical rejection ( SCR ) in kidney transplant recipients remains controversial. Methods We conducted a survey through UNOS across US transplant centers regarding their approach to surveillance biopsies and reasons for the nonperformance of surveillance biopsies. Results Responses were obtained from 106/238 centers (45%), and only 18 (17%) of the centers performed surveillance biopsies on all patients and 22 (21%) performed biopsy for select cases. The most common time points for surveillance biopsies were 3 and 12 months post‐transplant. The common reasons for not performing biopsies were low yield (n = 44, 65%) and the belief that it will not change outcome (n = 24, 36%). The incidence of SC ‐ TCMR was ≥ 10% among 39% of centers. The mean serum creatinine was slightly worse by 0.06 mg/dL at 1 year and 0.07 mg/dL at 3 years among centers performing biopsy, P < .0001. The. 1‐and 3‐year Observed‐Expected (O‐E) graft survival was similar among centers performing biopsies vs. those not performing biopsy ( P = .07, .88). Conclusion Only 17% of US centers perform surveillance biopsies, with another 21% performing surveillance biopsies in select cases (among centers that responded to the survey). Greater uniformity in the approach and management of this condition is of paramount importance.