Moulin Bruno, Merville Pierre, Renaudin Karine, Buob David, Ferlicot Sophie, Delahousse Michel, Dantal Jacques, Albano Laetitia, Barbet Christelle, Mourad Georges, Noel Laure-Hélène
Service de Néphrologie-Transplantation, CHU Strasbourg, Hôpitaux Universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
J Transplant. 2012;2012:781263. doi: 10.1155/2012/781263. Epub 2012 Sep 5.
The clinical merit of surveillance kidney graft biopsies remains controversial. A retrospective, multicenter analysis evaluated 12-month surveillance biopsies (SB, 154 patients) versus no SB (NSB, 138 patients (11 with diagnostic biopsy)) in patients >18 months posttransplant with estimated GFR (eGFR) ≥30 mL/min. The primary objective was to describe renal function at 18 months post-transplant in patients with or without SB at month 12. Globally, most recipients in both cohorts were at low immunological risk (<10% of patients with PRA ≥30%). The immunosuppressive regimen remained unchanged following more than half of SB that exhibited chronic lesions (18/33, 54.5%). Mean (SD) eGFR at month 18 (primary endpoint) was 56 (19) mL/min/1.73 m² with SB and 54 (15) mL/min/1.73 m² with NSB (P = 0.48). In the SB group, slight nonspecific changes were observed in 51 cases, rejection (acute or chronic) in 6 cases, CNI-related toxicity in 15 cases, recurrence of initial disease in two cases, and interstitial fibrosis/tubular atrophy (IF/TA) in 83 cases (71.6%), of which 35 cases (30.2%) were grade II/III lesions. eGFR <50 mL/min/1.73 m² at month 6 predicted IF/TA grade II or III (OR 3.85, 95% CI 1.64, 9.05, P < 0.002). SB at 12 months posttransplant did not prompt significant modification of immunosuppression, and no renal benefit was observed.
肾移植监测活检的临床价值仍存在争议。一项回顾性多中心分析评估了移植后超过18个月且估计肾小球滤过率（eGFR）≥30 mL/min的患者中，12个月时进行监测活检（SB，154例患者）与未进行监测活检（NSB，138例患者（11例进行了诊断性活检））的情况。主要目的是描述在12个月时进行或未进行监测活检的患者在移植后18个月时的肾功能。总体而言，两个队列中的大多数受者免疫风险较低（PRA≥30%的患者<10%）。超过一半出现慢性病变的监测活检后（18/33，54.5%）免疫抑制方案保持不变。18个月时（主要终点）的平均（标准差）eGFR，SB组为56（19）mL/min/1.73 m²，NSB组为54（15）mL/min/1.73 m²（P = 0.48）。在SB组中，51例观察到轻微非特异性改变，6例出现排斥反应（急性或慢性），15例出现与钙调神经磷酸酶抑制剂（CNI）相关的毒性，2例出现初始疾病复发，83例（71.6%）出现间质纤维化/肾小管萎缩（IF/TA），其中35例（30.2%）为II/III级病变。6个月时eGFR<50 mL/min/1.73 m²可预测IF/TA II级或III级（OR 3.85，95%CI 1.64，9.05，P<0.002）。移植后12个月时进行监测活检并未促使免疫抑制发生显著改变，也未观察到对肾脏有益的效果。
