Protocol transplant biopsies: Are they really needed?

被引:62
作者
Wilkinson, Alan [1 ]
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA 90095 USA
来源
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2006年 / 1卷 / 01期
关键词
D O I
10.2215/CJN.00350705
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Studies suggest that surveillance or protocol biopsies that are performed during the first year after kidney transplantation may be clinically useful in identifying early acute rejection or chronic allograft nephropathy at a point when they may be amenable to treatment. Although the benefit of this approach has yet to be evaluated in large, multicenter, prospective trials, numerous studies suggest that implementation of protocol biopsies may improve long-term graft function. In particular, a number of reports suggest that detection of chronic allograft nephropathy in early protocol biopsies is predictive of subsequent graft function and loss and that early treatment may have a dramatic effect on the outcome of the graft. Protocol biopsies also have the potential to be of great value in high-risk patients, such as those with delayed graft function, by allowing for early intervention for acute rejection. Furthermore, the procedure seems to be relatively straightforward and safe. Nevertheless, paucity of data has meant that clear proof of a benefit of early treatment of subclinical rejection and chronic allograft nephropathy detected by protocol biopsy is lacking. Moreover, the optimal timing of protocol biopsies and reliable methods to quantify the histologic changes observed in biopsy specimens have yet to be determined. This review discusses the pros and cons of protocol biopsies and considers the place of this procedure in the routine treatment of kidney transplant patients.
引用
收藏
页码:130 / 137
页数:8
相关论文
共 37 条
[1]   Protocol biopsies after kidney transplantation [J].
Böhmig, GA ;
Regele, H ;
Hörl, WH .
TRANSPLANT INTERNATIONAL, 2005, 18 (02) :131-139
[2]  
BRUNO DA, 2005, AM TRANSPL C MAY 20
[3]   Clinical significance of an early protocol biopsy in living-donor renal transplantation: Ten-year experience at a single center [J].
Choi, BS ;
Shin, MJ ;
Shin, SJ ;
Kim, YS ;
Choi, YJ ;
Kim, YS ;
Moon, IS ;
Kim, SY ;
Koh, YB ;
Bang, BK ;
Yang, CW .
AMERICAN JOURNAL OF TRANSPLANTATION, 2005, 5 (06) :1354-1360
[4]  
DIMENY E, 1995, CLIN TRANSPLANT, V9, P79
[5]   Significance of chronic transplant nephropathy on early protocol biopsies for graft outcome in pediatric renal transplantation [J].
Fujisawa, M ;
Ono, H ;
Isotani, S ;
Higuchi, A ;
Iijima, K ;
Yoshiya, K ;
Arakawa, S ;
Matsumoto, O ;
Nakamura, H ;
Kamidono, S ;
Yoshikawa, N .
TRANSPLANTATION PROCEEDINGS, 1999, 31 (03) :1687-1690
[6]   Protocol biopsy of the stable renal transplant:: A multicenter study of methods and complication rates [J].
Furness, PN ;
Philpott, CM ;
Chorbadjian, MT ;
Nicholson, ML ;
Bosmans, JL ;
Corthouts, BL ;
Bogers, JJPM ;
Schwarz, A ;
Gwinner, W ;
Haller, H ;
Mengel, M ;
Seron, D ;
Moreso, F ;
Cañas, C .
TRANSPLANTATION, 2003, 76 (06) :969-973
[7]   Maintenance immunosuppression: New agents and persistent dilemmas [J].
Gonin, JM .
ADVANCES IN RENAL REPLACEMENT THERAPY, 2000, 7 (02) :95-116
[8]  
GWINNER G, 2005, AM TRANSPL C MAY 20
[9]   Acute rejection in protocol renal transplant biopsies - Institutional variations [J].
Jain, S ;
Curwood, V ;
Kazi, J ;
White, SA ;
Furness, PN ;
Nicholson, ML .
TRANSPLANTATION PROCEEDINGS, 2000, 32 (03) :616-616
[10]  
Jain S, 2000, TRANSPL INT S1, V13, P52