Surveillance biopsies are superior to functional studies for the diagnosis of acute and chronic renal allograft pathology in children

Surveillance biopsies are superior to functional studies for the diagnosis of acute and chronic renal allograft pathology in children

:  In this report of our 3‐yr protocol biopsy program, we describe the evolution of acute rejection (AR) and chronic renal allograft nephropathy (CAN) in a cohort of 21 children treated with antibody induction, tacrolimus, mycophenolate mofetil, and prednisone. The aims of this study were to compare...

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Bibliographic Details
Published in:Pediatric transplantation Vol. 8; no. 1; pp. 29 - 38
Main Authors: Birk, Patricia E., Stannard, Karen M., Konrad, Helen B., Blydt-Hansen, Tom D., Ogborn, Malcolm R., Cheang, Mary S., Gartner, John G., Gibson, Ian W.
Format: Journal Article
Language:English
Published: Oxford, UK Munksgaard International Publishers 01-02-2004
Blackwell
Subjects:
Acute Disease
Biological and medical sciences
Biopsy
Child
Chronic Disease
Clinical Protocols
Disease Progression
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
General aspects
graft rejection
Graft Rejection - diagnosis
Humans
Immunosuppressive Agents - therapeutic use
kidney transplantation
Kidney Transplantation - pathology
Male
Medical sciences
needle
pediatric
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
Survival Analysis
Time Factors
Transplantation, Homologous
Graft(material)
Pediatrics
kidney transplantation
Transplantation
Homotransplantation
Kidney
pediatric
Immunology
Surgery
Graft
Diagnosis
Child
Human
Immunopathology
graft rejection
Acute
Functional
Rejection
Anatomic pathology
Chronic
Treatment
Urinary system
Surveillance
Biopsy
Needle
Syringe
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Summary::  In this report of our 3‐yr protocol biopsy program, we describe the evolution of acute rejection (AR) and chronic renal allograft nephropathy (CAN) in a cohort of 21 children treated with antibody induction, tacrolimus, mycophenolate mofetil, and prednisone. The aims of this study were to compare the pathogenicity of clinical acute rejection (CAR) and subclinical acute rejection (SAR), and to determine whether functional studies accurately represent acute and chronic renal allograft pathology in pediatric recipients with disproportionately large grafts. Using concurrent biopsies, we evaluated: (i) the utility of changes in the baseline sCr (ΔsCr) to predict both the onset of AR and the response to immunosuppressive therapy; and (ii) the relationship of the calculated creatinine clearance and the presence of pathologic proteinuria to the severity of CAN. We performed 112 biopsies: 11 donor, 73 protocol, 16 acute graft dysfunction and 12 1‐month follow‐up AR therapy. CAR and SAR were similar in incidence, timing and histologic severity. Progression of CAN was associated with the first episode of CAR (p < 0.02) and the cumulative number of episodes of CAR (p < 0.01), SAR (p < 0.05), CAR plus SAR (p < 0.002) and borderline SAR (B‐SAR) (p < 0.006). One‐month post‐treatment ΔsCrs could not distinguish 1‐month follow‐up biopsies with histologically confirmed worsened or unchanged AR from those with improved histology (35.2 ± 74.8% vs. 23.8 ± 24.9%, p = NS). These findings led to the addition of anti‐lymphocyte antibody therapy in five of 10 (50%) cases. Despite 100% 3‐yr actuarial graft survival and excellent function (GFR = 111 ± 36 mL/min/1.73 m2), 18 of 21 (86%) patients had grade I CAN or greater chronic histology at a mean ± sd follow‐up period of 18.2 ± 13.1 months. Thirteen of 21 (62%) patients progressed to grade I CAN at 5.2 ± 3.6 months and five (38%) of these patients progressed to grade II CAN at 17.8 ± 11.3 months. Schwartz GFR did not differ between patients with or without CAN (108 ± 38 mL/min/1.73 m2 vs. 127 ± 8 mL/min/1.73 m2, p = NS). In biopsies with CAN and no associated AR, neither the Banff chronic tubulointerstitial (Banff ci) score nor the Banff chronic grade correlated with the GFR. Proteinuria was not associated with CAN. Clinical AR and SAR are similar histologic lesions with a capacity for CAN progression. In pediatric renal transplant recipients, longitudinal protocol biopsies are superior to functional studies for the diagnosis and post‐therapeutic monitoring of AR and for the surveillance of CAN.
Bibliography:istex:B8C0EB7A22FF49BF2BFCFE0333664D0E59D4F37F
ark:/67375/WNG-JJDR5GPS-8
ArticleID:PETR122
ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1397-3142
1399-3046
DOI:10.1046/j.1397-3142.2003.00122.x