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Utility of protocol biopsy for the early diagnosis of transplanted kidney dysfunction
Author(s) -
Ushigome Hidetaka,
Sakai Kazuki,
Suzuki Tomoyuki,
Nobori Syuji,
Yoshizawa Atsushi,
Kaihara Satoshi,
Okamoto Masahiko,
Urasaki Koji,
Yoshimura Norio
Publication year - 2008
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/j.1399-0012.2008.00841.x
Subject(s) - medicine , transplantation , kidney transplantation , asymptomatic , tubulopathy , subclinical infection , nephrotoxicity , tacrolimus , biopsy , kidney , urology , prednisolone , chronic allograft nephropathy , renal function , nephrology , gastroenterology , surgery
We performed protocol kidney biopsies for the early diagnosis of asymptomatic histopathological acute rejection (AR), commonly defined as subclinical rejection and drug nephrotoxicity. Forty‐seven kidney recipients that had asymptomatic and stable kidney function underwent protocol biopsies both one month and one yr after kidney transplantation. The protocol biopsies one month after transplantation revealed borderline change in 13 of 47 cases (27.6%). AR 1a was observed in eight cases (17.2%) and AR 1b was observed in three cases (6.4%). The AR 1a and AR 1b groups were treated with methyl prednisolone pulse and deoxyspergualin. Toxic tubulopathy was found in four cases (8.5%). In the cases of nephrotoxicity, cyclosporine or tacrolimus was reduced. The borderline change group was observed without any additional treatment. Every case diagnosed with acute rejection one month after transplantation improved histopathologically one yr after transplantation, and the borderline change group partially remained borderline change and partially improved histopathologically one yr after transplantation. The nephrotoxicity group improved histopathologically one yr after transplantation. In our institution, protocol biopsies one month and one yr after kidney transplantation proved useful in screening for subclinical rejection and toxic tubulopathy and subsequently effective in improving long‐term graft survival.