Surveillance biopsies in children post-kidney transplant

Patricia E Birk, Patricia E Birk

Abstract

Surveillance biopsies are increasingly used in the post-transplant monitoring of pediatric renal allograft recipients. The main justification for this procedure is to diagnose early and presumably modifiable acute and chronic renal allograft injury. Pediatric recipients are theoretically at increased risk for subclinical renal allograft injury due to their relatively large adult-sized kidneys and their higher degree of immunological responsiveness. The safety profile of this procedure has been well investigated. Patient morbidity is low, with macroscopic hematuria being the most common adverse event. No patient deaths have been attributed to this procedure. Longitudinal surveillance biopsy studies have revealed a substantial burden of subclinical immunological and non-immunological injury, including acute cellular rejection, interstitial fibrosis and tubular atrophy, microvascular lesions and transplant glomerulopathy. The main impediment to the implementation of surveillance biopsies as the standard of care is the lack of demonstrable benefit of early histological detection on long-term outcome. The considerable debate surrounding this issue highlights the need for multicenter, prospective, and randomized studies.

Figures

Fig. 1
Fig. 1
a Surveillance renal allograft biopsy showing acute cellular subclinical rejection (A-SCR) with tubulitis (t2), PAS stain. b Surveillance renal allograft biopsy showing borderline cellular subclinical rejection (B-SCR) with minimal interstitial infiltrates (i1) and mild tubulitis (t1), PAS stain
Fig. 2
Fig. 2
a Surveillance renal allograft biopsy showing subclinical AMR with diffuse C4d + staining of peritubular capillaries and b Peritubular capillaritis (ptc2)

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