Kidney allograft surveillance biopsy practices across US transplant centers: A UNOS survey. Issue 5 (23rd March 2017)

• Record Type: Journal Article
• Authors: Mehta, Rajil; Cherikh, Wida; Sood, Puneet; Hariharan, Sundaram
• Is Part Of: Clinical transplantation. Volume 31:Issue 5(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-03-23
• Subjects: graft survival -- protocol biopsy -- rejection -- rejection -- subclinical -- T‐cell mediated rejection (TCMR); Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.12945
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Background: The approach to the diagnosis and management of subclinical rejection (SCR) in kidney transplant recipients remains controversial. Methods: We conducted a survey through UNOS across US transplant centers regarding their approach to surveillance biopsies and reasons for the nonperformance of surveillance biopsies. Results: Responses were obtained from 106/238 centers (45%), and only 18 (17%) of the centers performed surveillance biopsies on all patients and 22 (21%) performed biopsy for select cases. The most common time points for surveillance biopsies were 3 and 12 months post‐transplant. The common reasons for not performing biopsies were low yield (n = 44, 65%) and the belief that it will not change outcome (n = 24, 36%). The incidence of SC‐TCMR was ≥ 10% among 39% of centers. The mean serum creatinine was slightly worse by 0.06 mg/dL at 1 year and 0.07 mg/dL at 3 years among centers performing biopsy, P < .0001. The. 1‐and 3‐year Observed‐Expected (O‐E) graft survival was similar among centers performing biopsies vs. those not performing biopsy ( P = .07, .88). Conclusion: Only 17% of US centers perform surveillance biopsies, with another 21% performing surveillance biopsies in select cases (among centers that responded to the survey). Greater uniformity in the approach and management of this condition is of paramount importance.