Renal Transplant Unit, Bambino Gesù Children's Research Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
Pathology Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy.
Pediatr Nephrol. 2018 Nov;33(11):2167-2175. doi: 10.1007/s00467-018-4007-2. Epub 2018 Jul 6.
Kidney transplantation is the best treatment for children with end-stage kidney disease. Early results have improved, but late graft loss is still a major problem. Non-invasive, fully reliable early biomarkers of acute rejection are currently missing.
Our aim was to evaluate the efficacy of protocol biopsies (PBXs) in a pediatric population. During 11 years, 209 renal transplantations were performed in 204 pediatric patients. Biopsies were performed 3-6 months, 1 year, and 5 years after transplantation. Procedure-related complications were systematically looked for by means of ultrasound scans.
Unexpected findings (mainly subclinical rejections) requiring therapeutic intervention were found in 19.3% biopsies performed at 3-6 months, in 18.4% in 12-month biopsies and in none of those performed after 5 years. The 13.6% patients at 12-month biopsies and 23.6% at 5-year biopsies showed calcineurin inhibitor (CNI) toxicity. Interstitial fibrosis and tubular atrophy (IF/TA) was found in 17.6 and 83.6% of patients at 12-month and 5-year biopsies, respectively. Complications of the PBX were infrequent. Five-year estimated glomerular filtration rate (GFR) was not significantly different in patients who received treatment for any cause and patients with normal histology.
Although we do not have a control group, we may speculate that patients who received treatment returned to a "standard" condition possibly improving final outcome. Protocol biopsies are a powerful diagnostic tool for the management of pediatric renal transplant recipients. In view of the lack of evidence that biopsies taken 5 years after transplantation lead to any therapeutic change, their use should be reconsidered.
肾移植是治疗儿童终末期肾病的最佳方法。早期结果有所改善，但晚期移植物丢失仍然是一个主要问题。目前缺乏非侵入性、完全可靠的急性排斥反应早期生物标志物。
我们的目的是评估协议活检（PBX）在儿科人群中的效果。在 11 年期间，204 名儿科患者进行了 209 例肾移植。活检在移植后 3-6 个月、1 年和 5 年进行。通过超声扫描系统地寻找与操作相关的并发症。
在 3-6 个月进行的活检中，19.3%发现了需要治疗干预的意外发现（主要是亚临床排斥反应），在 12 个月的活检中为 18.4%，在 5 年后的活检中则没有。在 12 个月的活检中，13.6%的患者和在 5 年的活检中，23.6%的患者出现钙调磷酸酶抑制剂（CNI）毒性。在 12 个月和 5 年的活检中，分别有 17.6%和 83.6%的患者出现间质纤维化和肾小管萎缩（IF/TA）。PBX 的并发症并不常见。接受任何原因治疗的患者和组织学正常的患者的 5 年估计肾小球滤过率（GFR）没有显著差异。
尽管我们没有对照组，但我们可以推测，接受治疗的患者恢复到“标准”状态，可能改善最终结果。协议活检是管理儿科肾移植受者的有力诊断工具。鉴于没有证据表明移植后 5 年进行的活检会导致任何治疗变化，应重新考虑其使用。
