ESPN 50th Annual Meeting

ESPN 2017


 
EVALUATION OF SAFETY AND EFFICACY OF FOLLOW-UP BIOPSIES IN MONITORING RENAL PAEDIATRIC TRANSPLANT
GERMANA LONGO GIULIA FREGONESE 1 ELISA BENETTI 1 DAVIDE MENEGHESSO 1 MATTIA PAROLIN 1 ENRICO VIDAL 1 ANDREA CARRARO 2 SUSANNA NEGRISOLO 2 LUISA MURER 1

1- UNIVERSITY HOSPITAL OF PADOVA, PEDIATRIC NEPHROLOGY, DIALYSIS AND TRANSPLANT UNIT, DEPARTMENT OF WOMEN’S AND CHILDREN’S HEALTH, PADUA, ITALY
2- LABORATORY OF IMMUNOPATHOLOGY AND MOLECULAR BIOLOGY OF THE KIDNEY, WOMEN’S AND CHILDREN’S HEALTH DEPARTMENT, UNIVERSITY OF PADUA, PADUA, ITALY
 
Introduction:

Surveillance allograft biopsies could provide the opportunity to tailor the patient’s management based on evidence of subclinical histological changes with potentially important implication for graft outcome. 

Material and methods:

We evaluated all protocol biopsies performed in our Center from January 2007 to December 2015 at 6, 12 and 24 months post-transplant. The primary aim of our study was to evaluate the efficacy of the histological surveillance in preventing functional decay of renal allograft. The secondary aim was to evaluate the prevalence/severity of post-bioptic complications.

 

Results:

234 biopsies have been performed in 115 patients (M/F 74/41, m. age 10,9±6,9 y). Subclinical histological changes were observed in 73/234 that lead to clinical therapies change in 67/73 cases. 41 subclinical acute rejection (34% Banff type 3, 53% Banff type 4 IA/IB, 12% Banff type 2) have been trated with methylprednisolone pulses and immunosoppression adjustement, plus Ig ev and Rituximab in the 5 cases of acute humoral rejection. 18 cases with CNI toxicity and 6 cases of IF/TA have been treated with low calcineurin doses +/- mTOR inhibitor. 1 case of intrarenal PTLD was treated with Rituximab. We observed 24/234 complications: in 4/234 (1,7%) procedures there were major complications including three intraparenchimal AVF resolved with endovascular procedure. 20/234 (8,5%) minor complications all solved spontaneously.

Conclusions:

Our study confirmed the efficacy and safety of protocol biopsies for guiding post-transplant management and improving the renal allograft outcome in paediatric patients.