Mehta Rajil, Cherikh Wida, Sood Puneet, Hariharan Sundaram
Division of Renal and Electrolytes and Division of Transplant Surgery, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
United Network of Organ Sharing, Richmond, VA, USA.
Clin Transplant. 2017 May;31(5). doi: 10.1111/ctr.12945. Epub 2017 Mar 23.
The approach to the diagnosis and management of subclinical rejection (SCR) in kidney transplant recipients remains controversial.
We conducted a survey through UNOS across US transplant centers regarding their approach to surveillance biopsies and reasons for the nonperformance of surveillance biopsies.
Responses were obtained from 106/238 centers (45%), and only 18 (17%) of the centers performed surveillance biopsies on all patients and 22 (21%) performed biopsy for select cases. The most common time points for surveillance biopsies were 3 and 12 months post-transplant. The common reasons for not performing biopsies were low yield (n = 44, 65%) and the belief that it will not change outcome (n = 24, 36%). The incidence of SC-TCMR was ≥ 10% among 39% of centers. The mean serum creatinine was slightly worse by 0.06 mg/dL at 1 year and 0.07 mg/dL at 3 years among centers performing biopsy, P < .0001. The. 1-and 3-year Observed-Expected (O-E) graft survival was similar among centers performing biopsies vs. those not performing biopsy (P = .07, .88).
Only 17% of US centers perform surveillance biopsies, with another 21% performing surveillance biopsies in select cases (among centers that responded to the survey). Greater uniformity in the approach and management of this condition is of paramount importance.
肾移植受者亚临床排斥反应（SCR）的诊断和管理方法仍存在争议。
我们通过器官共享联合网络（UNOS）对美国各移植中心进行了一项调查，了解他们进行监测活检的方法以及不进行监测活检的原因。
从238个中心中的106个（45%）获得了回复，只有18个（17%）中心对所有患者进行监测活检，22个（21%）中心对部分病例进行活检。监测活检最常见的时间点是移植后3个月和12个月。不进行活检的常见原因是活检阳性率低（n = 44，65%）以及认为活检不会改变结果（n = 24，36%）。39%的中心中，亚临床T细胞介导的排斥反应（SC-TCMR）发生率≥10%。进行活检的中心1年时平均血清肌酐略差0.06 mg/dL，3年时略差0.07 mg/dL，P <.0001。进行活检的中心与未进行活检的中心1年和3年的观察到的预期（O-E）移植肾存活率相似（P = 0.07，0.88）。
在美国，只有17%的中心进行监测活检，另外21%（在回复调查的中心中）对部分病例进行监测活检。在这种情况的处理方法和管理上实现更大的一致性至关重要。
