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Benefits and risks of protocol biopsies in pediatric renal transplantation

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Abstract

Protocol biopsies are defined as sampling of allograft tissue at predetermined times regardless of function. This procedure can be justified due to the lack of non-invasive methods to reliably diagnose rejection (acute or subclinical). Changes in creatinine are not seen with subclinical rejection or early acute rejection and do not always correlate with efficacy of treatment. Parents and providers are still hesitant to pursue protocol biopsy due to the potential complications and lack of definitive evidence of a benefit from doing this procedure. Importantly, the rate of transplant renal biopsy complications requiring additional intervention is low. It is unclear if detection and treatment of subclinical rejection detected on protocol biopsy will lead to improved graft survival. Our goal is to review the literature on this topic and share some of the experience in our center. Definition, indications, and complications of diagnostic transplant renal biopsies are not included in this review.

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References

  1. Rose EM, Kennedy SE, Mackie FE (2016) Surveillance biopsies after paediatric kidney transplantation: a review. Pediatr Transplant 20:748–755

    Article  PubMed  Google Scholar 

  2. Qvist E, Their M, Krogerus L, Holmberg C, Jalanko H (2007) Early treatment of acute rejections gives favorable long-term function after renal transplantation in small children. Pediatr Transplant 11:895–900

    Article  PubMed  CAS  Google Scholar 

  3. Nankivell B, Borrows RJ, Fung CL, O'Connell PJ, Allen RD, Chapman JR (2004) Natural history, risk factors, and impact of subclinical rejection in kidney transplantation. Transplantation 78:242–249

    Article  PubMed  Google Scholar 

  4. Nankivell BJ, Chapman JR (2006) The significance of subclinical rejection and the value of protocol biopsies. Am J Transplant 6:2006–2012

    Article  PubMed  CAS  Google Scholar 

  5. Birk PE, Blydt-Hansen TD, Dart AB, Kaita LM, Proulx C, Taylor G (2007) Low incidence of adverse events in outpatient pediatric renal allograft biopsies. Pediatr Transplant 11:196–200

    Article  PubMed  Google Scholar 

  6. Hymes LC (2011) Protocol biopsy-driven interventions after pediatric renal transplantation. Pediatr Transplant 15:539–540

    Article  PubMed  Google Scholar 

  7. Kanzelmeyer NK, Ahlenstiel T, Drube J, Froede K, Kreuzer M, Broecker V, Ehrich JH, Melk A, Pape L (2010) Protocol biopsy-driven interventions after pediatric renal transplantation. Pediatr Transplant 14:1012–1018

    Article  PubMed  CAS  Google Scholar 

  8. Birk PE (2012) Surveillance biopsies in children post-kidney transplant. Pediatr Nephrol 27:753–760

    Article  PubMed  Google Scholar 

  9. Birk PE, Stannard KM, Konrad HB, Blydt-Hansen TD, Ogborn MR, Cheang MS, Gartner JG, Gibson IW (2004) Surveillance biopsies are superior to functional studies for the diagnosis of acute and chronic renal allograft pathology in children. Pediatr Transplant 8:29–38

    Article  PubMed  Google Scholar 

  10. Furness PE, Philpott CM, Chorbadjian MT, Nicholson ML, Bosmans JL, Corthouts BL, Bogers JJ, Schwarz A, Gwinner W, Haller H, Mengel M, Seron D, Moreso F, Cañas C (2003) Protocol biopsy of the stable renal transplant: a multicenter study of methods and complication rates. Transplantation 76:969–973

    Article  PubMed  Google Scholar 

  11. Moreso F, Ibernon M, Gomà M, Carrera M, Fulladosa X, Hueso M, Gil-Vernet S, Cruzado JM, Torras J, Grinyó JM, Serón D (2006) Subclinical rejection associated with chronic allograft nephropathy in protocol biopsies as a risk factor for late graft loss. Am J Transplant 6:747–752

    Article  PubMed  CAS  Google Scholar 

  12. Roberts ID, Stratopoulos C, Zilvetti M, Reddy S, Friend PJ (2009) Impact of immunosuppression on the incidence of early subclinical renal allograft rejection: implications for protocol biopsy policy. Transpl Int 22:831–836

    Article  PubMed  CAS  Google Scholar 

  13. Hergesell O, Felten H, Andrassy K, Kühn K, Ritz E (1998) Safety of ultrasound-guided percutaneous renal biopsy-retrospective analysis of 1090 consecutive cases. Nephrol Dial Transplant 13:975–977

    Article  PubMed  CAS  Google Scholar 

  14. Eckman M, Erban JK, Singh SK, Kao MS (2003) Screening for the risk of bleeding or thrombosis. Ann Intern Med 138:W15–W24

    Article  PubMed  Google Scholar 

  15. Bandari J, Fuller TW, Turner Іі RM, D'Agostino LA (2016) Renal biopsy for medical renal disease: indications and contraindications. Can J Urol 23:8121–8126

    PubMed  Google Scholar 

  16. Thaunat O, Legendre C, Morelon E, Kreis H, Mamzer-Bruneel MF (2007) To biopsy or not to biopsy? Should we screen the histology of stable renal grafts? Transplantation 84:671–676

    Article  PubMed  Google Scholar 

  17. Franke M, Kramarczyk A, Taylan C, Maintz D, Hoppe B, Koerber F (2014) Ultrasound-guided percutaneous renal biopsy in 295 children and adolescents: role of ultrasound and analysis of complications. PLoS One 9:e114737

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Rush D, Nickerson P, Gough J, McKenna R, Grimm P, Cheang M, Trpkov K, Solez K, Jeffery J (1998) Beneficial effects of treatment of early subclinical rejection: a randomized study. J Am Soc Nephrol 9:2129–2134

    PubMed  CAS  Google Scholar 

  19. Buchmann TN, Wolff T, Bachmann A, Guerke L, Steiger J, Mihatsch MJ, Dickenmann M (2012) Repeat true surveillance biopsies in kidney transplantation. Transplantation 93:908–913

    Article  PubMed  Google Scholar 

  20. Rush D, Arlen D, Boucher A, Busque S, Cockfield SM, Girardin C, Knoll G, Lachance JG, Landsberg D, Shapiro J, Shoker A, Yilmaz S (2007) Lack of benefit of early protocol biopsies in renal transplant patients receiving TAC and MMF: a randomized study. Am J Transplant 7:2538–2545

    Article  PubMed  CAS  Google Scholar 

  21. Kurtkoti J, Sakhuja V, Sud K, Minz M, Nada R, Kohli HS, Gupta KL, Joshi K, Jha V (2008) The utility of 1-and 3-month protocol biopsies on renal allograft function: a randomized controlled study. Am J Transplant 8:317–323

    Article  PubMed  CAS  Google Scholar 

  22. Tøndel C, Vikse BE, Bostad L, Svarstad E (2012) Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988–2010. Clin J Am Soc Nephrol 7:1591–1597

    Article  PubMed  PubMed Central  Google Scholar 

  23. Vidhun J, Masciandro J, Varich L, Salvatierra O Jr, Sarwal M (2003) Safety and risk stratification of percutaneous biopsies of adult-sized renal allografts in infant and older pediatric recipients. Transplantation 76:552–557

    Article  PubMed  Google Scholar 

  24. Riccabona M, Schwinger W, Ring E (1998) Arteriovenous fistula after renal biopsy in children. J Ultrasound Med 17:505–508

    Article  PubMed  CAS  Google Scholar 

  25. Vignali C, Lonzi S, Bargellini I, Cioni R, Petruzzi P, Caramella D, Bartolozzi C (2004) Vascular injuries after percutaneous renal procedures: treatment by transcatheter embolization. Eur Radiol 14:723–729

    Article  PubMed  Google Scholar 

  26. Shishido S, Asanuma H, Nakai H, Mori Y, Satoh H, Kamimaki I, Hataya H, Ikeda M, Honda M, Hasegawa A (2003) The impact of repeated subclinical acute rejection on the progression of chronic allograft nephropathy. J Am Soc Nephrol 14:1046–1052

    Article  PubMed  Google Scholar 

  27. Seikku P, Krogerus L, Jalanko H, Holmberg C (2005) Better renal function with enhanced immunosuppression and protocol biopsies after kidney transplantation in children. Pediatr Transplant 9:754–762

    Article  PubMed  CAS  Google Scholar 

  28. Kasiske BL, Cohen D, Lucey MR, Neylan JF (2000) Payment for immunosuppression after organ transplantation. JAMA 283:2445–2450

    Article  PubMed  CAS  Google Scholar 

  29. Gloor JM, Cohen AJ, Lager DJ, Grande JP, Fidler ME, Velosa JA, Larson TS, Schwab TR, Griffin MD, Prieto M, Nyberg SL, Sterioff S, Kremers WK, Stegall MD (2002) Subclinical rejection in tacrolimus-treated renal transplant recipients. Transplantation 73:1965–1967

    Article  PubMed  Google Scholar 

  30. Curtis JJ (2007) Protocol biopsy: today’s fine-needle aspiration biopsy? Transplantation 84:677–678

    Article  PubMed  Google Scholar 

  31. Lo DJ, Kaplan B, Kirk AD (2014) Biomarkers for kidney transplant rejection. Nat Rev Nephrol 10:215–225

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Nephrology, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA

    Roberto Gordillo, Raj Munshi & Jodi M. Smith

  2. Division of Radiology, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA

    Eric J. Monroe & Giridhar M. Shivaram

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  1. Roberto Gordillo
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  2. Raj Munshi
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  3. Eric J. Monroe
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  4. Giridhar M. Shivaram
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  5. Jodi M. Smith
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Correspondence to Roberto Gordillo.

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The authors declare that they have no conflict of interest.

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Answer to questions:

1. e; 2. d; 3. e; 4. a; 5. b

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Gordillo, R., Munshi, R., Monroe, E.J. et al. Benefits and risks of protocol biopsies in pediatric renal transplantation. Pediatr Nephrol 34, 593–598 (2019). https://doi.org/10.1007/s00467-018-3959-6

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  • DOI: https://doi.org/10.1007/s00467-018-3959-6

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