scholarly journals Protocol biopsy and subclinical rejection in patients after kidney transplantation treated by tacrolimus (Prograf)

2003 ◽  
Vol 147 (2) ◽  
pp. 193-196 ◽  
Author(s):  
Josef Zadrazil ◽  
Karel Krejci ◽  
Sadek Al Jabry ◽  
Vladko Horcicka ◽  
Tomas Tichy ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Protocol Biopsy ◽  
Subclinical Rejection

scholarly journals P1643TORQUE TENO VIRUS FOR RISK STRATIFICATION OF SUBCLINICAL GRAFT REJECTION AFTER KIDNEY TRANSPLANTATION- A PROSPECTIVE STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Konstantin Doberer ◽  
Georg A Böhmig ◽  
Elisabeth Puchhammer-Stöckl ◽  
Gregor Bond
Keyword(s):  
Kidney Transplantation ◽  
Graft Rejection ◽  
Graft Function ◽  
Type I ◽  
Kidney Graft ◽  
Protocol Biopsy ◽  
Patients At Risk ◽  
Subclinical Rejection ◽  
High Level ◽  
A Prospective Study

Abstract Background and Aims Non-invasive monitoring strategies are insufficient to detect patients at risk for subclinical graft rejection after kidney transplantation. The highly prevalent and non-pathogenic Torque Teno virus (TTV) reflects the immunocompetence of its host: high level viraemia indicates strong and low level viraemia weak immunosuppression, respectively. Thus TTV replication might serve as a candidate for immunologic monitoring. Method To analyze the association between TTV and subclinical kidney graft rejection, an interim analysis of the prospective “TTV POET” cohort study (DRKS00012335) was performed including data available until 31/01/2019. All consecutive kidney graft recipients transplanted at the Medical University Vienna since 01/12/2016 (n=308) with a protocol biopsy 12 months after transplantation (n=47; median 12.4 months) and stable graft function were included. Biopsy results according to current BANFF classification were analyzed in the context of peripheral blood TTV levels quantified by PCR. Results Graft function was excellent (median eGFR MDRD: 57 ml/min/1.73m2, urinary PKR: 92 mg/g). Twenty recipients (43%) had subclinical rejection (borderline TCMR, n=16; ABMR, n=3; TCMR type I, n=1). TTV level quantified at the date of biopsy was lower in recipients with rejection compared to recipients without rejection. The risk for rejection increased by 11% with each log level decrease in TTV copies/ml (RR 0.89, 95% CI 0.85-0.93; p<0.001). Differences in TTV levels were evident not only at the date of biopsy, but already 6 weeks earlier. Patients with biopsies showing chronic leasons, suggesting ongoing allo-reactivity, had a longer period of time with TTV levels <1x106 copies/ml. Conclusion Our data suggests an association between TTV level and subclinical graft rejection at 12 months after kidney transplantation. Future clinical trials are necessary to test the potential of TTV guided immunosuppression to reduce subclinical rejection.

scholarly journals Clinical Significance of Renal Allograft Protocol Biopsies: A Single Tertiary Center Experience in Malaysia

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Mei Sian Fu ◽  
Soo Jin Lim ◽  
Maisarah Jalalonmuhali ◽  
Kee Seong Ng ◽  
Soo Kun Lim ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Allograft ◽  
De Novo ◽  
Early Recognition ◽  
Bk Virus ◽  
Baseline Serum ◽  
Protocol Biopsy ◽  
Tertiary Center ◽  
Protocol Biopsies ◽  
Subclinical Rejection

Background. The role of protocol renal allograft biopsy in kidney transplantation is controversial due to the concern with procedural-related complications; however, its role is slowly evolving. Recent evidence suggests that protocol biopsy is useful in detecting subclinical renal pathology. Early recognition and treatment of renal pathologies can improve long-term outcomes of renal allografts. Methodology. A total of 362 renal allograft protocol biopsies were performed in adult recipients of kidney transplantation between 2012 and 2017. After excluding those with poor quality or those performed with a baseline serum creatinine level >200 umol/L, we analyzed 334 (92.3%) biopsies. Histology reports were reviewed and categorized into histoimmunological and nonimmunological changes. The immunological changes were subcategorized into the following: (1) no acute rejection (NR), (2) borderline changes (BC), and (3) subclinical rejection (SCR). Nonimmunological changes were subcategorized into the following: (1) chronicity including interstitial fibrosis/tubular atrophy (IFTA), chronic T-cell-mediated rejection (TCMR), unspecified chronic lesions, and arterionephrosclerosis, (2) de novo glomerulopathy/recurrence of primary disease (RP), and (3) other clinically unsuspected lesions (acute pyelonephritis, calcineurin inhibitors toxicity, postinfective glomerulonephritis, and BK virus nephropathy). Risk factors associated with SCR were assessed. Results. For the histoimmunological changes, 161 (48.2%) showed NR, 145 (43.4%) were BC, and 28 (8.4%) were SCR. These clinical events were more pronounced for the first 5 years; our data showed BC accounted for 59 (36.4%), 64 (54.2%), and 22 (40.7%) biopsies within <1 year, 1-5 years, and > 5 years, respectively (p = 0.011). Meanwhile, the incidence for SCR was 6 (3.7%) biopsies in <1 year, 18 (15.3%) in 1-5 years, and 4 (7.4%) in >5 years after transplantation (p=0.003). For the nonimmunological changes, chronicity, de novo glomerulopathy/RP, and other clinically unsuspected lesions were seen in 40 (12%), 10 (3%), and 12 (3.6%) biopsies, respectively. Living-related donor recipients were associated with decreased SCR (p=0.007). Conclusions. Despite having a stable renal function, our transplant recipients had a significant number of subclinical rejection on renal allograft biopsies.

scholarly journals P1663CLINICAL AND PATHOLOGICAL FACTORS INFLUENCING RESIDUAL RENAL FUNCTION AFTER LIVING DONOR NEPHRECTOMY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Akihiro Okubo ◽  
Hideki Yokoi ◽  
Kaoru Sakai ◽  
Takeshi Matsubara ◽  
Motoko Yanagita
Keyword(s):  
Renal Function ◽  
Kidney Transplantation ◽  
University Hospital ◽  
Kidney Volume ◽  
Nephron Number ◽  
Kidney Donors ◽  
Protocol Biopsy ◽  
Living Kidney Donors ◽  
Post Transplant ◽  
Factors Influencing

Abstract Background and Aims Renal function decreases with aging. Aging is associated with significant changes in structure and function of the kidney. On the macrostructural level, kidney cortical volume decreases, therefore total kidney volume (TKV) also decreases with aging. On the microstructural level, the number of glomerulosclerosis increases, therefore nephron number decreases with aging. Some reports show that the decline of TKV and nephron number is accompanied by a reduction in renal function. However, in the field of living kidney transplantation, TKV and glomerulosclerosis are not fully evaluated as factors influencing the donor’s post-transplant renal function. Living kidney transplantation is an established renal replacement therapy for end-stage renal disease patients. To predict living kidney recipient’s renal function, one-hour protocol biopsy is conducted during the operation. From one-hour protocol biopsy, donor’s pathophysiological findings such as glomerulosclerosis can be evaluated. In this study, we evaluated the correlation of potential influencing factors including TKV and glomerulosclerosis with pre- and post-transplant renal function in living kidney donors. Method This is a retrospective study including all 37 living related kidney donors seen at Kyoto University Hospital from January 2013 to April 2019. Estimated glomerular filtration rate (eGFR) was calculated using equation for Japanese population from serum creatinine levels at pre- and post-transplant. TKV was calculated from the 3D volume-rendered images of enhanced CT (=π/6×length×width×thickness), and adjusted to standard body surface area (BSA) by individual BSA. The ratio of number of non-glomerulosclerosis per that of whole glomeruli (non-GS) was evaluated by protocol renal biopsy at one hour after renal reperfusion. This study protocol was approved by the Ethics Committee on human research of the Graduate School of Medicine, Kyoto University. Results We evaluated 37 living kidney donors (35.1% male, mean age 58.2 ± 12.0 years). Mean pre-transplant eGFR was 75.7 ± 12.1 ml/min/1.73m2, mean post-transplant eGFR; 44.9 ± 7.75 ml/min/1.73m2, adjusted TKV (aTKV); 349.3 ± 58.4 ml, and non-GS; 0.892 ± 0.086. Pre-transplant eGFR was associated with aTKV and aTKV×nonGS (r=0.525, 0.569 respectively, p&lt;0.01). Post-transplant eGFR was associated with age (≧65 years old, p&lt;0.01), aTKV, non-GS, and aTKV×non-GS (r=0.527, 0.344, 0.626 respectively, p&lt;0.05). The rate of eGFR decline was associated with age (≧65 years old, p=0.044), but not with aTKV and non-GS, aTKV×non-GS. Conclusion These results suggest that non-GS and age are correlated with post-transplant renal function but not pre-transplant renal function in living kidney donor, and the decline rate of eGFR are correlated with age.

scholarly journals Economic analysis of screening for subclinical rejection in kidney transplantation using protocol biopsies and noninvasive biomarkers

2020 ◽  
Vol 21 (1) ◽  
pp. 186-197
Author(s):  
Chethan M. Puttarajappa ◽  
Rajil B. Mehta ◽  
Mark S. Roberts ◽  
Kenneth J. Smith ◽  
Sundaram Hariharan
Keyword(s):  
Kidney Transplantation ◽  
Economic Analysis ◽  
Protocol Biopsies ◽  
Subclinical Rejection ◽  
Noninvasive Biomarkers

scholarly journals Recurrent glomerular disease after kidney transplantation: An update of selected areas and the impact of protocol biopsy

Nephrology ◽  
2014 ◽  
Vol 19 ◽  
pp. 6-10 ◽  
Author(s):  
Kunio Morozumi ◽  
Asami Takeda ◽  
Yasuhiro Otsuka ◽  
Keiji Horike ◽  
Norihiko Gotoh ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Glomerular Disease ◽  
Protocol Biopsy ◽  
The Impact
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