Clinical application of protocol kidney allograft biopsies after kidney transplantation: a single-center prospective observational cohort study
10.3760/cma.j.cn421203-20241122-00231
- VernacularTitle:肾移植后移植肾程序性活检临床应用的单中心前瞻性观察性队列分析
- Author:
Huangjie WU
1
;
Yi FANG
;
Jing LUO
;
Yangyan LIU
;
Lilin LIU
;
Yingchun WU
;
Chunsun DAI
;
Min GU
;
Hongdi CAO
Author Information
1. 南京医科大学第二附属医院肾脏病中心，南京 210003
- Publication Type:Journal Article
- Keywords:
Kidney transplantation;
Protocol biopsy;
Rejection
- From:
Chinese Journal of Organ Transplantation
2025;46(10):710-716
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical application of protocol biopsy (PB) during postoperative follow-up in recipients of allogeneic kidney transplantation.Methods:A prospective observational cohort study was conducted. Recipients who underwent allogeneic kidney transplantation at the Second Affiliated Hospital of Nanjing Medical University between January 2022 and September 2024 and received PB at 3 months (±1 week) and/or 12 months (±4 weeks) post-transplantation in the Department of Nephrology were enrolled. The implementation, complications, and pathological results of PB were summarized. The safety and diagnostic efficacy of PB were analyzed.Results:A total of 143 allogeneic kidney transplant recipients were included, and 200 PB procedures were performed. The overall implementation rate of protocol biopsy (PB) was 84.1% (143/170). Among them, 170 recipients completed 3-month follow-up, and 136 PBs were performed at 3 months (±1 week) post-transplantation, with an implementation rate of 80.0%. Seventy-nine recipients completed 12-month follow-up, and 64 PBs were performed at 12 months (±4 weeks), with an implementation rate of 81.0%. One major PB-related complication occurred (0.5%), presenting as gross hematuria and diagnosed as a transplant renal arteriovenous fistula. At 3 months post-transplantation, 58 biopsies (42.6%) showed pathological abnormalities, including rejection in 12 cases (8.8%), borderline changes in 18 cases (13.2%), BK virus nephropathy (BKVN) in 10 cases (7.4%), calcineurin inhibitor (CNI) nephrotoxicity in 13 cases (9.6%), and recurrent kidney disease in 5 cases (3.7%). At 12 months post-transplantation, 22 biopsies (34.4%) revealed pathological abnormalities, including rejection in 13 cases (20.3%), borderline changes in 4 cases (6.3%), BKVN in 3 cases (4.7%), CNI nephrotoxicity in 1 case (1.6%), and recurrent disease in 1 case (1.6%).Conclusions:Protocol kidney allograft biopsy after allogeneic kidney transplantation is highly safe and feasible in clinical practice. PB provides significant diagnostic value for the early detection of subclinical rejection and BKVN, thereby supporting its clinical utility in postoperative monitoring and management.
