Lim Manuel, Park Byung Kwan, Lee Kyo Won, Park Jae Berm, Kim Kyeong Deok, Yang Jaehun, Kwon Jieun, Jeong Eun Sung, Lee Seunghwan
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
J Clin Med. 2022 Jan 31;11(3):785. doi: 10.3390/jcm11030785.
Protocol biopsy in renal allograft helps to early detect subclinical rejection (SCR) in patients who have no abnormal clinical and laboratory findings. Still, there are rare reports about the techniques and outcomes of two-week protocol biopsy. The aim of this study was to assess two-week protocol biopsy regarding the technical feasibility, procedure safety, and clinical outcomes.
A total of 894 protocol biopsies were performed in adult recipients between 2012 and 2019. Two-week and one-year protocol biopsies were guided with ultrasound in 842 and 399 patients by one of four radiologists with wide range of biopsy experience, respectively. These protocol biopsies were compared in terms of feasibility and safety. Standard references were clinico-laboratory findings and biopsy examinations.
The median period of two-week and one-year protocol biopsies were 12 days (10-20 days) and 383 days (302-420 days), respectively. All protocol biopsies were technically successful and there was no difference between radiologists regarding technical success and complications ( 0.453). Major complication (Clavien-Dindo grading II-IV) rates of two-week and one-year protocol biopsies were 0.3% (3/842) and 0.2% (1/399), respectively ( 1.000). However, univariate analysis demonstrated that platelet count < 100 K/mL and blood urea nitrogen ≥ 40 mg/dL were associated with major complications in two-week protocol biopsy. The SCRs of these protocol biopsies were 15.4% (130/842) and 33.6% (134/399), respectively ( 0.001).
Two-week protocol biopsy is technically feasible and safe. It contributes to early detecting a substantial number of SCRs. Prior to the biopsy, platelet count and blood urea nitrogen should be carefully checked to predict major complications.
肾移植术后的方案活检有助于在临床和实验室检查无异常的患者中早期发现亚临床排斥反应（SCR）。然而，关于两周方案活检技术及结果的报道仍较为罕见。本研究旨在评估两周方案活检在技术可行性、操作安全性及临床结果方面的情况。
2012年至2019年间，对成年受者共进行了894次方案活检。分别由四位具有广泛活检经验的放射科医生之一，在超声引导下对842例患者进行两周方案活检，对399例患者进行一年方案活检。对这些方案活检在可行性和安全性方面进行比较。标准参考为临床实验室检查结果及活检检查。
两周方案活检和一年方案活检的中位时间分别为12天（10 - 20天）和383天（302 - 420天）。所有方案活检在技术上均获成功，且在技术成功率和并发症方面放射科医生之间无差异（P = 0.453）。两周方案活检和一年方案活检的严重并发症（Clavien - Dindo分级II - IV级）发生率分别为0.3%（3/842）和0.2%（1/399）（P = 1.000）。然而，单因素分析表明，血小板计数<100 K/mL和血尿素氮≥40 mg/dL与两周方案活检中的严重并发症相关。这些方案活检的SCR发生率分别为15.4%（130/842）和33.6%（134/399）（P < 0.001）。
两周方案活检在技术上可行且安全。它有助于早期发现大量的SCR。活检前应仔细检查血小板计数和血尿素氮以预测严重并发症。
