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Related Concept Videos

Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

59
A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
74

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Using a Chemical Biopsy for Graft Quality Assessment
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Protocol Biopsies in Delayed Graft Function Kidney Transplants From Brain-Dead Donors.

Amanda Ahlmark1, Ville Sallinen1, Anne Räisänen-Sokolowski2

  • 1Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Clinical Transplantation
|July 15, 2025
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Delayed graft function (DGF) in kidney transplants often leads to acute rejection. While the first biopsy is crucial, later biopsies show rejection in only 10% of cases, suggesting a need to re-evaluate current biopsy guidelines.

Keywords:
acute rejectionbrain‐dead donorsdelayed graft functionhistologykidney transplantsprotocol biopsy

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Area of Science:

  • Nephrology
  • Transplant Surgery
  • Immunology

Background:

  • Delayed graft function (DGF) affects one-third of deceased donor kidney transplant recipients, increasing acute rejection risk.
  • Current guidelines recommend sequential protocol biopsies for DGF kidneys, based on older immunosuppression data.
  • Decreasing acute rejection rates necessitate re-evaluating the utility of routine post-transplant protocol biopsies.

Purpose of the Study:

  • To assess the diagnostic yield of sequential protocol biopsies in the first month post-transplant for deceased donor kidney recipients with DGF.
  • To determine the incidence and timing of acute rejection episodes in DGF kidneys under modern immunosuppression protocols.
  • To re-evaluate the clinical relevance of protocol biopsies in the context of current immunosuppression strategies.

Main Methods:

  • Retrospective analysis of 1022 protocol biopsies from 678 deceased donor kidney recipients with DGF (2006-2023).
  • All recipients received corticosteroid induction; some received anti-thymocyte globulin or basiliximab.
  • Histological review of biopsies taken within the first month post-transplant.

Main Results:

  • 178 out of 678 recipients (26%) experienced acute rejection, predominantly within 7-10 days post-transplant.
  • In cases with no rejection on the first biopsy, subsequent biopsies revealed rejection in 10% of cases.
  • Donor-specific antibodies were linked to higher rates of antibody-mediated rejection (20% vs. 1.3%).

Conclusions:

  • The initial post-transplant biopsy is vital for detecting early acute rejection in DGF kidneys.
  • Rejection occurred in only 10% of DGF kidney transplants without rejection in the first biopsy.
  • Borderline findings on biopsy progressed to rejection in approximately one-third of cases, highlighting their significance.