Comparison of graft and patient survival according to the transplantation centre policy for 1-year screening biopsy among stable kidney recipients: a propensity score-based study

• Published in: Nephrology, dialysis, transplantation Vol. 34; no. 4; pp. 703 - 711
• Main Authors: Couvrat-Desvergnes, Grégoire, Foucher, Yohann, Le Borgne, Florent, Dion, Angelina, Mourad, Georges, Garrigue, Valérie, Legendre, Christophe, Rostaing, Lionel, Kamar, Nassim, Kessler, Michèle, Ladrière, Marc, Morelon, Emmanuel, Buron, Fanny, Giral, Magali, Dantan, Etienne
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-04-2019
• Subjects: Female; Graft Rejection - diagnosis; Graft Rejection - etiology; Graft Rejection - mortality; Graft Survival; Human health and pathology; Humans; Kidney Diseases - mortality; Kidney Diseases - surgery; Kidney Transplantation - adverse effects; Kidney Transplantation - mortality; Life Sciences; Male; Mass Screening - legislation & jurisprudence; Middle Aged; Prognosis; Propensity Score; Prospective Studies; Survival Rate; causal inference; graft failure; clinical utility; kidney transplantation; screening biopsy
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfy221

Abstract
Background. The clinical utility of screening biopsies (SBs) at 1 year post-transplantation is still debated, especially for stable kidney graft recipients. Given the heterogeneity in practices between transplantation centres, the objective of this study was to compare graft and patient survival of stable patients according to whether they were followed up in a transplantation centre with or without a policy for having an SB at 1 year post-transplantation.
Materials. From a French multicentre cohort, we studied 1573 kidney recipients who were alive with stable graft function at 1 year post-transplantation, with no acute rejection in their first year post-transplantation.
Results. Using propensity score-based analyses, we did not observe any significant difference in the relative risk for graft failure between patients from centres with a 1-year SB policy and those from other centres [hazard ratio = 1.15, 95% confidence interval (CI) 0.86–1.53]. The corresponding adjusted survival probability at 8 years post-transplantation was 69% (95% CI 61–74%) for patients from centres with a 1-year SB policy versus 74% (95% CI 67–79%) for those from other centres.
Conclusion. A 1-year SB policy for stable patients may not lead to therapeutical benefits for improved graft and patient survival. Further studies examining the benefits versus the risks of a 1-year SB policy are warranted to demonstrate the long-term utility of this intervention.