[The usefulness of protocol biopsies after kidney transplant: pros and cons]

Transplant centers carrying out protocol biopsies in kidney transplant recipients do so to make an early diagnosis of subclinical rejection or chronic transplant glomerulopathy. However, proof is still lacking to document that an early diagnosis of subclinical rejection is useful to improve long-term outcome. Protocol biopsies represent a classical controversy in renal transplantation and it is still not clear whether the benefits outweigh the risks. In this paper the authors will elucidate the pros and cons of protocol biopsies and identify issues where consensus is mandatory. Protocol biopsies need to be performed in the following clinical conditions: at the time of transplantation to obtain information about the transplanted kidney; in the case of prolonged delayed graft function; in patients at increased immunological risk; and in the case of clinical trials performed to assess the safety and efficacy of new immunosuppressive drugs.