Early Renal Protocol Biopsies: For Some But Not For All Renal Transplant Patients?
Autor(a) principal: | |
---|---|
Data de Publicação: | 2015 |
Outros Autores: | , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.17/3122 |
Resumo: | Subclinical rejection following renal transplant is associated with worse outcomes, which can be prevented if recognized early. Protocol allograft biopsies have emerged as an option to identify and allow treatment of subclinical rejection, but optimal timing for their performance is not established. We retrospectively evaluated a cohort of 52 low immunological risk patients, who were submitted, from 2007 to 2010, to de novo renal transplant. We separated them into two groups depending on performing an early graft protocol biopsy before hospital discharge: Group A – 32 patients (61.5%) performed a protocol biopsy, and group B – 20 patients (38.5%) did not, the biopsy being considered not essential for various reasons. We analysed patients’ demographics, biopsy complications, graft function, rejection episodes, and patient and graft survival for a median follow-up time of 63.3 months (50.3-83.7). Group A and group B differed in gender (more female patients were biopsied), dialysis vintage (higher in group A), human leucocyte antigen mismatch (higher in group A), and induction protocol (more patients submitted to thymoglobulin than to basiliximab in group A). Protocol biopsy detected histological changes in four patients (12.5%) in group A (2 cellular and 2 borderline rejections), and all were treated accordingly. Moderate peri-graft hematoma was reported in two cases (3.9%). Despite the increased risk in group A, renal function at discharge was better than in group B (p < 0.05 for serum creatinine and eGFR). During follow-up, rejection episodes were similar in the two groups. By the end of follow-up (median 63.3 months), proteinuria and renal function were similar between the two groups. Using a multivariate regression model, and despite the initial differences, at the end of follow-up, patients submitted to early protocol biopsies had similar excellent prognosis as the very low-risk patients who were not biopsied. (p = 0.5). Following our results, we propose that timing of early protocol biopsy should be individualized according to the patient’s clinical and immunological risk. |
id |
RCAP_bbe58c9c75843c1d593248fc316c0867 |
---|---|
oai_identifier_str |
oai:repositorio.chlc.min-saude.pt:10400.17/3122 |
network_acronym_str |
RCAP |
network_name_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository_id_str |
7160 |
spelling |
Early Renal Protocol Biopsies: For Some But Not For All Renal Transplant Patients?Biópsias Renais Protocoladas Precoces: Uma Ferramenta Útil em Alguns Mas Não em Todos os Transplantados Renais?Protocol BiopsyRenal Allograft BiopsyRenal TransplantSubclinical RejectionHCC NEFSubclinical rejection following renal transplant is associated with worse outcomes, which can be prevented if recognized early. Protocol allograft biopsies have emerged as an option to identify and allow treatment of subclinical rejection, but optimal timing for their performance is not established. We retrospectively evaluated a cohort of 52 low immunological risk patients, who were submitted, from 2007 to 2010, to de novo renal transplant. We separated them into two groups depending on performing an early graft protocol biopsy before hospital discharge: Group A – 32 patients (61.5%) performed a protocol biopsy, and group B – 20 patients (38.5%) did not, the biopsy being considered not essential for various reasons. We analysed patients’ demographics, biopsy complications, graft function, rejection episodes, and patient and graft survival for a median follow-up time of 63.3 months (50.3-83.7). Group A and group B differed in gender (more female patients were biopsied), dialysis vintage (higher in group A), human leucocyte antigen mismatch (higher in group A), and induction protocol (more patients submitted to thymoglobulin than to basiliximab in group A). Protocol biopsy detected histological changes in four patients (12.5%) in group A (2 cellular and 2 borderline rejections), and all were treated accordingly. Moderate peri-graft hematoma was reported in two cases (3.9%). Despite the increased risk in group A, renal function at discharge was better than in group B (p < 0.05 for serum creatinine and eGFR). During follow-up, rejection episodes were similar in the two groups. By the end of follow-up (median 63.3 months), proteinuria and renal function were similar between the two groups. Using a multivariate regression model, and despite the initial differences, at the end of follow-up, patients submitted to early protocol biopsies had similar excellent prognosis as the very low-risk patients who were not biopsied. (p = 0.5). Following our results, we propose that timing of early protocol biopsy should be individualized according to the patient’s clinical and immunological risk.Sociedade Portuguesa de NefrologiaRepositório do Centro Hospitalar Universitário de Lisboa Central, EPENavarro, DFerreira, ACCaeiro, FNolasco, FCotovio, PAires, ISilva, CRemédio, FFerreira, AViana, HCarvalho, F2018-12-04T10:55:24Z20152015-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/3122engPort J Nephrol Hypert 2015; 29(4): 316-322info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:41:21Zoai:repositorio.chlc.min-saude.pt:10400.17/3122Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:20:27.515351Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Early Renal Protocol Biopsies: For Some But Not For All Renal Transplant Patients? Biópsias Renais Protocoladas Precoces: Uma Ferramenta Útil em Alguns Mas Não em Todos os Transplantados Renais? |
title |
Early Renal Protocol Biopsies: For Some But Not For All Renal Transplant Patients? |
spellingShingle |
Early Renal Protocol Biopsies: For Some But Not For All Renal Transplant Patients? Navarro, D Protocol Biopsy Renal Allograft Biopsy Renal Transplant Subclinical Rejection HCC NEF |
title_short |
Early Renal Protocol Biopsies: For Some But Not For All Renal Transplant Patients? |
title_full |
Early Renal Protocol Biopsies: For Some But Not For All Renal Transplant Patients? |
title_fullStr |
Early Renal Protocol Biopsies: For Some But Not For All Renal Transplant Patients? |
title_full_unstemmed |
Early Renal Protocol Biopsies: For Some But Not For All Renal Transplant Patients? |
title_sort |
Early Renal Protocol Biopsies: For Some But Not For All Renal Transplant Patients? |
author |
Navarro, D |
author_facet |
Navarro, D Ferreira, AC Caeiro, F Nolasco, F Cotovio, P Aires, I Silva, C Remédio, F Ferreira, A Viana, H Carvalho, F |
author_role |
author |
author2 |
Ferreira, AC Caeiro, F Nolasco, F Cotovio, P Aires, I Silva, C Remédio, F Ferreira, A Viana, H Carvalho, F |
author2_role |
author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Navarro, D Ferreira, AC Caeiro, F Nolasco, F Cotovio, P Aires, I Silva, C Remédio, F Ferreira, A Viana, H Carvalho, F |
dc.subject.por.fl_str_mv |
Protocol Biopsy Renal Allograft Biopsy Renal Transplant Subclinical Rejection HCC NEF |
topic |
Protocol Biopsy Renal Allograft Biopsy Renal Transplant Subclinical Rejection HCC NEF |
description |
Subclinical rejection following renal transplant is associated with worse outcomes, which can be prevented if recognized early. Protocol allograft biopsies have emerged as an option to identify and allow treatment of subclinical rejection, but optimal timing for their performance is not established. We retrospectively evaluated a cohort of 52 low immunological risk patients, who were submitted, from 2007 to 2010, to de novo renal transplant. We separated them into two groups depending on performing an early graft protocol biopsy before hospital discharge: Group A – 32 patients (61.5%) performed a protocol biopsy, and group B – 20 patients (38.5%) did not, the biopsy being considered not essential for various reasons. We analysed patients’ demographics, biopsy complications, graft function, rejection episodes, and patient and graft survival for a median follow-up time of 63.3 months (50.3-83.7). Group A and group B differed in gender (more female patients were biopsied), dialysis vintage (higher in group A), human leucocyte antigen mismatch (higher in group A), and induction protocol (more patients submitted to thymoglobulin than to basiliximab in group A). Protocol biopsy detected histological changes in four patients (12.5%) in group A (2 cellular and 2 borderline rejections), and all were treated accordingly. Moderate peri-graft hematoma was reported in two cases (3.9%). Despite the increased risk in group A, renal function at discharge was better than in group B (p < 0.05 for serum creatinine and eGFR). During follow-up, rejection episodes were similar in the two groups. By the end of follow-up (median 63.3 months), proteinuria and renal function were similar between the two groups. Using a multivariate regression model, and despite the initial differences, at the end of follow-up, patients submitted to early protocol biopsies had similar excellent prognosis as the very low-risk patients who were not biopsied. (p = 0.5). Following our results, we propose that timing of early protocol biopsy should be individualized according to the patient’s clinical and immunological risk. |
publishDate |
2015 |
dc.date.none.fl_str_mv |
2015 2015-01-01T00:00:00Z 2018-12-04T10:55:24Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/3122 |
url |
http://hdl.handle.net/10400.17/3122 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Port J Nephrol Hypert 2015; 29(4): 316-322 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
|
_version_ |
1799131300670472192 |