Sub-clinical acute rejection detected using protocol biopsies in patients with delayed graft function

Area of Science:

• Nephrology
• Transplant Surgery
• Immunology

Background:

• Diagnosing acute rejection in renal transplant recipients with delayed graft function (DGF) is challenging.
• Sub-clinical acute rejection episodes may contribute to graft dysfunction.
• Early detection and treatment are crucial for graft survival.

Purpose of the Study:

• To evaluate the utility of protocol renal transplant biopsies in detecting sub-clinical acute rejection episodes.
• To assess the incidence of sub-clinical acute rejection in patients with and without DGF.
• To determine the safety and efficacy of routine biopsies in the early post-transplant period.

Main Methods:

• Eighty-three renal transplant recipients were included; 33 had DGF.
• Protocol biopsies were performed at 7 days post-transplant under ultrasound guidance.
• Patients with DGF underwent weekly biopsies until graft function was restored.

Main Results:

• Sub-clinical acute rejection was detected in 18% of patients with DGF versus 4% in those without DGF (P < 0.05).
• Borderline rejection was observed in 12% of patients with DGF and 8% without.
• No significant morbidity was associated with the biopsy procedures.

Conclusions:

• Protocol renal transplant biopsies are effective in identifying sub-clinical acute rejection, particularly in patients with DGF.
• The high detection rate and low morbidity support the recommendation of routine biopsies for DGF patients.
• This strategy may improve early graft management and long-term outcomes.