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Clinical Significance of Renal Allograft Protocol Biopsies: A Single Tertiary Center Experience in Malaysia
Joint Authors
Jalalonmuhali, Maisarah
Fu, Mei Sian
Lim, Soo Jin
Ng, Kee Seong
Lim, Soo Kun
Ng, Kok Peng
Source
Issue
Vol. 2019, Issue 2019 (31 Dec. 2019), pp.1-8, 8 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2019-05-02
Country of Publication
Egypt
No. of Pages
8
Main Subjects
Abstract EN
Background.
The role of protocol renal allograft biopsy in kidney transplantation is controversial due to the concern with procedural-related complications; however, its role is slowly evolving.
Recent evidence suggests that protocol biopsy is useful in detecting subclinical renal pathology.
Early recognition and treatment of renal pathologies can improve long-term outcomes of renal allografts.
Methodology.
A total of 362 renal allograft protocol biopsies were performed in adult recipients of kidney transplantation between 2012 and 2017.
After excluding those with poor quality or those performed with a baseline serum creatinine level >200 umol/L, we analyzed 334 (92.3%) biopsies.
Histology reports were reviewed and categorized into histoimmunological and nonimmunological changes.
The immunological changes were subcategorized into the following: (1) no acute rejection (NR), (2) borderline changes (BC), and (3) subclinical rejection (SCR).
Nonimmunological changes were subcategorized into the following: (1) chronicity including interstitial fibrosis/tubular atrophy (IFTA), chronic T-cell-mediated rejection (TCMR), unspecified chronic lesions, and arterionephrosclerosis, (2) de novo glomerulopathy/recurrence of primary disease (RP), and (3) other clinically unsuspected lesions (acute pyelonephritis, calcineurin inhibitors toxicity, postinfective glomerulonephritis, and BK virus nephropathy).
Risk factors associated with SCR were assessed.
Results.
For the histoimmunological changes, 161 (48.2%) showed NR, 145 (43.4%) were BC, and 28 (8.4%) were SCR.
These clinical events were more pronounced for the first 5 years; our data showed BC accounted for 59 (36.4%), 64 (54.2%), and 22 (40.7%) biopsies within <1 year, 1-5 years, and > 5 years, respectively (p = 0.011).
Meanwhile, the incidence for SCR was 6 (3.7%) biopsies in <1 year, 18 (15.3%) in 1-5 years, and 4 (7.4%) in >5 years after transplantation (p=0.003).
For the nonimmunological changes, chronicity, de novo glomerulopathy/RP, and other clinically unsuspected lesions were seen in 40 (12%), 10 (3%), and 12 (3.6%) biopsies, respectively.
Living-related donor recipients were associated with decreased SCR (p=0.007).
Conclusions.
Despite having a stable renal function, our transplant recipients had a significant number of subclinical rejection on renal allograft biopsies.
American Psychological Association (APA)
Fu, Mei Sian& Lim, Soo Jin& Jalalonmuhali, Maisarah& Ng, Kee Seong& Lim, Soo Kun& Ng, Kok Peng. 2019. Clinical Significance of Renal Allograft Protocol Biopsies: A Single Tertiary Center Experience in Malaysia. Journal of Transplantation،Vol. 2019, no. 2019, pp.1-8.
https://search.emarefa.net/detail/BIM-1192462
Modern Language Association (MLA)
Fu, Mei Sian…[et al.]. Clinical Significance of Renal Allograft Protocol Biopsies: A Single Tertiary Center Experience in Malaysia. Journal of Transplantation No. 2019 (2019), pp.1-8.
https://search.emarefa.net/detail/BIM-1192462
American Medical Association (AMA)
Fu, Mei Sian& Lim, Soo Jin& Jalalonmuhali, Maisarah& Ng, Kee Seong& Lim, Soo Kun& Ng, Kok Peng. Clinical Significance of Renal Allograft Protocol Biopsies: A Single Tertiary Center Experience in Malaysia. Journal of Transplantation. 2019. Vol. 2019, no. 2019, pp.1-8.
https://search.emarefa.net/detail/BIM-1192462
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1192462