Background

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.

Methods

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.

Results

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.

Conclusions

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.

中文翻译：

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表征在小儿肾脏同种异体移植接受者的监测活检中观察到的可改变的组织学变化的频率。

背景

在小儿肾脏移植人群中，排斥反应造成的移植物损失接近50％。早期识别和治疗同种异体移植损伤，特别是可修改的病理学，例如亚临床排斥反应（SCR），钙调神经磷酸酶抑制剂毒性和BK病毒性肾病，可能会改善同种异体移植物的生存。方案监测活检（SB）当前提供了针对性干预措施的最早机会。

方法

这是对2008年至2016年在97名小儿肾脏移植受者中获得的215个肾脏SB进行的单中心回顾性回顾。在移植后6、12和24个月获得SB。记录异常组织学发现的频率，SB时估计的肾小球滤过率以及SB相关并发症。分析数据以调查可能的时间趋势以及人口统计或临床与异常组织学发现的关联。

结果

在所有SB中，有38.1％的患者可观察到可能的组织学改变。在所有时间点发现SCR的频率均增加，移植后每增加6个月发现SCR的几率估计增加49％（aOR 1.49，95％CI 1.06-2.09，p = 0.022）。在接受SCR治疗的患者的随访活检中，有50％没有SCR，有18.8％的患者在组织学上有改善。与SB相关的并发症发生率为1.9％（4/215 SBs），仅包括轻微并发症。

结论

SB是安全的，并提供了机会来识别和治疗小儿肾脏移植人群的组织学改变。SB移植后长达2年的性能可能会产生有意义的临床影响。