ESPN 50th Annual Meeting

ESPN 2017


 
Post-Kidney Transplant Annual Protocol Biopsies For Five Years in Children
İlke Taşkırdı 1 Belde Kasap Demir 2 Caner Alparslan 3 Eren Soyaltın 3 Seçil Arslansoyu Çamlar 3 Serdar Sarıtaş 1 Cengiz Han Elmas 1 Elif Perihan Öncel 1 Demet Alaygut 3 Fatma Mutlubaş 3 Cem Tuğmen 4 Önder Yavaşcan 3

1- İZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL, DEPARMENT OF PEDIATRICS
2- İZMIR KATIP ÇELEBI UNIVERSITY, DEPARTMENT OF PEDIATRIC NEPHROLOGY
3- İZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
4- İzmir Tepecik Training and Research Hospital, Organ Transplantation Unit
 
Introduction:

Protocol biopsy (PB) is an appropriate method for the early diagnosis of graft disorders. We aimed to evaluate the effectiveness and safety of annual BPs.

Material and methods:

Biopsies perfomed annually for 5 years in kidney transplant recipient children between October 2007-April 2017 were evaluated retrospectively. Gender, transplantation age, donor types, mismatches, treatment modalities, follow-up durations were recorded. Indication biopsies(IB), inappropriate samples(IS,<7 glomerulus) and unaccesible materials(UM) were excluded. All biopsies were scored (0-3) for peritubular capillaritis, glomerulitis, C4d staining, interstitial inflammation, tubulitis, intimal arteritis, vascular intimal fibrosis and arterial hyalinosis. Sum of the scores were notes as “Banff score(BS)”. Complications, interventions, concurrent serum creatinine, glomerular filtration rates(GFR) and proteinuria levels were recorded and their relation with BS was evaluated.

Results:

A total of 205 biopsies were performed in 42 patients (M/F: 22/20) between above-mentioned dates. When IBs(n:45), ISs(N:26) and UMs(n: 16) were excluded, there were 118 PBs (29 implantation, 89 follow-up). 40 of the patients received basiliximab for induction and 38 received steroid+tacrolimus+mycophenolate for initial maintenance therapy. The number of follow-up biopsies at 5th-year,4th-year,3rd-year,2nd-year and 1st-year were 7,16,16,20 and 30, respectively. Abnormalities were found in 10(%8,5) of the PBs (bordeline: 6, subclinical rejection: 4) and an intervention was made in 4 of them. Negative correlations between GFR and BS were significant in 4th and 5th year biopsies (p: 0.003,r: -0.685;p:0.004,r:-0.912,respectively). The rates of macroscopic hematuria (%10.4), perinefric hematoma (%4.3), arteriovenous fistula AVF(%1.7), transfusion(non) and radiological intervention (%0.8) were acceptable. There is no patient lost, 1 graft lost due to non-adherence and 2 patients with serum creatinine> 2.5 mg/dL due to chronic allograft nephropathy all through the follow-up duration.

Conclusions:

The treatment protocol and follow-up with annual protocol biopsies seems efficient and safe in children. Better results may be attained when all our patients complete the five-year period.