Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Department of Pathology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
Pediatr Transplant. 2021 Mar;25(2):e13869. doi: 10.1111/petr.13869. Epub 2020 Oct 19.
Due to a lack of consensus on SB for pediatric kidney transplant recipients, we evaluated the yield and clinical utility of SB findings at various time points post-transplant.
Patients transplanted at a single institution between 2014 and 2020 with at least one SB at 1.5, 3, 6, 12, and 24 months post-transplant were included. Additional biopsies were done for indication (IB). TCMR was classified by Banff criteria (score ≥i1t1).
Forty-seven patients had 142 biopsies (SB = 113, IB = 29); 19 (40.4%) of whom experienced at least one TCMR episode in the first-year post-transplant. The greatest SB yield of any pathologic abnormality was at 6 months (57.1%; P < .001). Six months also had the highest yield for TCMR (42.9%), compared with 3.3%, 20.8%, 15.0%, and 9.1% at 1.5, 3, 12 months, and 24 months, respectively (P = .003). SB instigated intensification of immunosuppression (28.3% cases), reduction of immunosuppression (2.7% cases), and other non-immunosuppressant changes (1.8% cases). The 6-month SB led to the greatest number of changes in management (53.6%), compared with 1.5, 3, 12, and 24 months (13.3, 20.8, 25.0, and 36.4%, respectively; P = .012). There were no major biopsy-related complications.
SBs identify an important burden of subclinical rejection and other pathology leading to changes in clinical management. The greatest yield was at 6 months, whereas the least utility was at the 1.5 months. Selection of SB timing may be tailored such that the optimal yield is balanced against the procedural risk.
由于缺乏小儿肾移植受者 SB 的共识，我们评估了移植后不同时间点 SB 检查的结果及其临床应用价值。
本研究纳入了 2014 年至 2020 年期间在单中心接受移植且在移植后 1.5、3、6、12 和 24 个月至少进行过一次 SB 检查的患者。因适应证行再次活检（IB）。采用 Banff 标准（评分≥i1t1）对 TCMR 进行分类。
47 例患者共进行了 142 次活检（SB=113，IB=29）；其中 19 例（40.4%）在移植后 1 年内至少经历了一次 TCMR 发作。6 个月时 SB 检查结果异常的比例最高（57.1%，P<0.001）。与 1.5、3、12 个月和 24 个月相比，6 个月时 TCMR 的检出率最高（42.9%），而 1.5、3、12 个月和 24 个月时的检出率分别为 3.3%、20.8%、15.0%和 9.1%（P=0.003）。SB 检查结果导致强化免疫抑制治疗（28.3%的病例）、减少免疫抑制治疗（2.7%的病例）和其他非免疫抑制剂治疗方案的改变（1.8%的病例）。与 1.5、3、12 和 24 个月相比，6 个月 SB 检查结果改变的病例数最多（53.6%），而 1.5、3、12 和 24 个月时分别为 13.3%、20.8%、25.0%和 36.4%（P=0.012）。没有与活检相关的重大并发症。
SB 检查可以发现大量亚临床排斥反应和其他病理改变，从而改变临床管理策略。6 个月时 SB 检查的检出率最高，而 1.5 个月时的检出率最低。SB 检查时间的选择可以根据最佳的检出率与操作风险进行平衡。
