Division of Graduate Medical Education, Children's Mercy Kansas City, Kansas City, MO, USA.
Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO, USA.
Pediatr Nephrol. 2020 Nov;35(11):2173-2182. doi: 10.1007/s00467-020-04624-1. Epub 2020 Jun 18.
Rejection is responsible for just under 50% of graft loss in the pediatric kidney transplant population. Early identification and treatment of allograft injury, specifically modifiable pathologies such as subclinical rejection (SCR), calcineurin inhibitor toxicity, and BK virus nephropathy, may improve allograft survival. Protocol surveillance biopsy (SB) currently offers the earliest opportunity for targeted interventions.
This is a single-center retrospective review of 215 kidney SBs obtained from 2008 to 2016 in 97 pediatric kidney transplant recipients. SBs were obtained at 6, 12, and 24 months post-transplantation. Frequency of abnormal histologic findings, estimated glomerular filtration rate at time of SB, and SB-related complications were recorded. Data were analyzed to investigate possible time trends and the presence of demographic or clinical associations with abnormal histologic findings.
Potentially modifiable histologic findings were seen in 38.1% of all SBs. SCR was found with increasing frequency across all time points with an estimated 49% increase in the odds of a SCR finding per additional 6 months post-transplantation (aOR 1.49, 95% CI 1.06-2.09, p = 0.022). Among follow-up biopsies in patients who underwent treatment for SCR, 50% had no SCR and 18.8% showed histologic improvement. The complication rate associated with SB was 1.9% (4/215 SBs) and consisted of only minor complications.
SBs are safe and offer the opportunity to identify and treat modifiable histologic changes in the pediatric kidney transplant population. The performance of SBs for up to 2 years after transplantation can have meaningful clinical impact.
排斥反应是导致儿科肾移植人群中近 50%移植物丢失的原因。早期识别和治疗同种异体损伤，特别是可改变的病变，如亚临床排斥反应（SCR）、钙调神经磷酸酶抑制剂毒性和 BK 病毒肾病，可能改善移植物的存活率。方案监测活检（SB）目前提供了进行靶向干预的最早机会。
这是对 2008 年至 2016 年间在 97 名儿科肾移植受者中进行的 215 次肾 SB 的单中心回顾性研究。SB 在移植后 6、12 和 24 个月获得。记录异常组织学发现的频率、SB 时的估计肾小球滤过率以及 SB 相关并发症。分析数据以调查可能的时间趋势以及异常组织学发现与人口统计学或临床因素的相关性。
所有 SB 中 38.1% 存在潜在可改变的组织学发现。随着时间的推移，SCR 的发生率逐渐增加，每增加 6 个月移植后 SCR 发现的几率增加 49%（优势比 1.49，95%可信区间 1.06-2.09，p = 0.022）。在接受 SCR 治疗的患者的随访活检中，50%的患者没有 SCR，18.8%的患者显示组织学改善。SB 相关并发症的发生率为 1.9%（215 次 SB 中有 4 次），且仅为轻微并发症。
SB 是安全的，为儿科肾移植人群提供了识别和治疗可改变的组织学变化的机会。在移植后 2 年内进行 SB 可产生有意义的临床影响。
