Two-Week Protocol Biopsy in Renal Allograft: Feasibility, Safety, and Outcomes

Area of Science:

• Nephrology
• Transplant Surgery
• Diagnostic Imaging

Background:

• Protocol biopsies in renal allografts aid in early detection of subclinical rejection (SCR).
• Limited data exists on the techniques and outcomes of early (two-week) protocol biopsies.
• This study evaluates the technical feasibility, safety, and clinical outcomes of two-week protocol biopsies.

Purpose of the Study:

• To assess the technical feasibility of two-week protocol biopsies in renal allograft recipients.
• To evaluate the safety and complication rates of two-week protocol biopsies compared to one-year biopsies.
• To determine the clinical utility of two-week protocol biopsies in detecting subclinical rejection.

Main Methods:

• 894 protocol biopsies were performed in adult renal allograft recipients between 2012 and 2019.
• Two-week and one-year protocol biopsies were ultrasound-guided by experienced radiologists.
• Biopsies were compared for technical success, safety, and complication rates against clinical and laboratory findings.

Main Results:

• All protocol biopsies were technically successful with no inter-radiologist variation in success or complications.
• Major complication rates were low and similar for two-week (0.3%) and one-year (0.2%) protocol biopsies.
• Two-week protocol biopsies detected SCR in 15.4% of patients, significantly lower than the 33.6% detected at one year.

Conclusions:

• Two-week protocol biopsy is a technically feasible and safe procedure for renal allograft recipients.
• This early biopsy strategy identifies a significant number of subclinical rejections.
• Pre-biopsy assessment of platelet count and blood urea nitrogen is crucial for predicting potential major complications.