The value of repeat biopsies in kidney allograft recipients with delayed graft function

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N. Sajadjan, M.C. van den Heuvel, T.M. Huijink, R.A. Pol, S.P. Berger

Chair(s): Prof. dr. L.B. Hilbrands & dr. H.M. Kwakkel-van Erp

Wednesday 8 march 2017

18:06 - 18:18h at Willem Pijperzaal

Categories: Parallel - Klinisch

Parallel session: Parallelsessie VI - Klinisch 1 - HLA-antilichamen en immunomodulatie

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Background:
Delayed graft function (DGF) is a frequent complication after deceased donor kidney transplantation. It is general practice to perform kidneys biopsies during the period of DGF to exclude early allograft rejection. These biopsies are usually performed at roughly 10 days after transplantation. It is less clear whether biopsies should be repeated if DGF persists after 2 weeks. Hence, we evaluated the timing and diagnostic value of repeat biopsies in patients with DGF.

Methods:
We included 619 deceased donor kidney transplantations performed between 2000 and 2007 at our centre. DGF was defined as the need for dialysis in the first week after transplantation. All biopsy reports were re-evaluated in accordance to the BANFF ‘09 classification. The results of the repeat biopsies were compared with the initial biopsy.

Results:
A total of 199 cases (32.2%) were identified as DGF, of which 73 cases (36.7%) underwent at least 2 biopsies during the DGF period. The initial biopsies (B1) were performed at 13±12 (mean±SD) days after transplantation and the repeat biopsies (B2) at 23±10 (mean±SD) days. B1 revealed 19 cases (26.0%) with rejection and 54 cases (74.0%) without rejection. At B2 there were 34 cases (46.6%) with rejection and 39 cases (53.4%) without rejection. From B1 to B2 we observed 31 new cases (57.4%) of rejection in patients who had no rejection in the initial biopsy (P<0.001). When looking at the repeat biopsies in patients who had rejection at B1, 8 of 19 cases (42.1%) had resolution of rejection at B2 despite persisting DGF (P=0.001). Of the other 11 cases with persistent rejection at B2, 4 had the same BANFF score, 4 a higher BANFF score and 3 a lower BANFF score in the repeat biopsy.

Conclusions:
There is a significant rate of new rejection cases in patients with persistent DGF if a kidney biopsy is repeated roughly 2 weeks after the first biopsy. Repeat biopsies during persisting DGF in patients with rejection at the first biopsy may prevent unnecessary escalation of rejection treatment. Our findings underscore the importance of repeat biopsies in patients with persistent DGF.