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Clinical Significance of an Early Protocol Biopsy in Living‐Donor Renal Transplantation: Ten‐Year Experience at a Single Center
Author(s) -
Choi Bum Soon,
Shin Mi Jung,
Shin Suk Joon,
Kim Young Soo,
Choi Yeong Jin,
Kim YongSoo,
Moon In Sung,
Kim Suk Young,
Koh Yong Bok,
Bang Byung Kee,
Yang Chul Woo
Publication year - 2005
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2005.00830.x
Subject(s) - subclinical infection , medicine , transplantation , odds ratio , incidence (geometry) , biopsy , gastroenterology , single center , basiliximab , kidney transplantation , immunosuppression , surgery , urology , physics , optics
We report here our 10‐year experience of a biopsy performed at day 14 after transplantation in 304 patients with stable graft function. The factors that may have influenced subclinical rejection were analyzed according to histology. The incidence of subclinical rejection was 13.2%. Addition of mycophenolate mofetile (MMF) as a primary immunosuppressant significantly decreased the incidence of subclinical rejection compared with patients without such treatment (odds ratio, 0.23; p < 0.05). On the other hand, HLA‐DR antigen mismatch (odds ratio, 2.39) and unrelated donor (odds ratio, 2.10) were also significantly associated with decreased subclinical rejection (p < 0.05). The incidence of acute rejection in patients with normal findings was lower than in those with borderline changes or subclinical rejection (0.23 ± 0.05 vs. 0.48 ± 0.07 and 0.60 ± 0.11, respectively; p < 0.05). The graft survival rates in patients with subclinical rejection were lower than in patients with normal or borderline changes at 1 (88.4% vs. 97.9% and 99.1%; p < 0.05), 5 (77.8% vs. 96.2% and 95.9%; p < 0.05) and 10 (62.3% vs. 96.2% and 93.7%; p < 0.05) years. Thus, a protocol biopsy performed on day 14 after transplantation is useful for predicting graft survival. Triple therapy including MMF, related donor and HLA‐DR antigen match are important factors for reducing subclinical rejection in living‐donor renal transplantation.