Characterizing the frequency of modifiable histological changes observed on surveillance biopsies in pediatric kidney al
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ORIGINAL ARTICLE
Characterizing the frequency of modifiable histological changes observed on surveillance biopsies in pediatric kidney allograft recipients James D. Odum 1 & Alexander Kats 2 & Judith Sebestyen VanSickle 3 & Vimal Chadha 3 & Brenda Brewer 3 & Vincent S. Staggs 4 & Bradley A. Warady 3 Received: 21 January 2020 / Revised: 18 May 2020 / Accepted: 19 May 2020 # IPNA 2020
Abstract 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. Keywords Pediatrics . Kidney . Transplant . Surveillance biopsies . Subclinical rejection . Calcineurin inhibitor toxicity . Interstitial fibrosis
Introduction
* Bradley A. Warady [email protected] 1
Division of Graduate Medical Education, Children’s Mercy Kansas City, Kansas City, MO, USA
2
Department of Pathology and Laboratory Medicine, Children’s Mercy Kansas City, Kansas City, MO, USA
3
Division of Pediatric Nephrology, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
4
Biostatistics & Epidemiology Core, Children’s Mercy Kansas City, Kansas City, MO, USA
Kidneys are the most commonly transplanted solid organ, with at least 17,000 allografts transplanted in the USA in each of the past 5 years. Pediatric patients receive approximately 700 of these transplants annually [1]. A kidney allograft is capable of surviving 20–25 years if well maintained, which is commonly sufficient for older adult transplant recipients [2].
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