An Analysis of Early Renal Transplant Protocol Biopsies - the High Incidence of Subclinical Tubulitis

Ron Shapiro, Parmjeet Randhawa, Mark L. Jordan, Velma P. Scantlebury, Carlos Vivas, Ashok Jain, Robert J. Corry, Jerry McCauley, James Johnston, Joseph Donaldson, Edward A. Gray, Igor Dvorchik, Thomas R. Hakala, John J. Fung, Thomas E. Starzl

Research output: Contribution to journalArticle

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Abstract

To investigate the possibility that we have been underestimating the true incidence of acute rejection, we began to perform protocol biopsies after kidney transplantation. This analysis looks at the one-week biopsies. Between March 1 and October 1, 1999, 100 adult patients undergoing cadaveric kidney or kidney/pancreas transplantation, or living donor kidney transplantation, underwent 277 biopsies. We focused on the subset of biopsies in patients without delayed graft function (DGF) and with stable or improving renal function, who underwent a biopsy 8.2 ± 2.6 d (range 3-18 d) after transplantation (n = 28). Six (21%) patients with no DGF and with stable or Improving renal function had borderline histopathology, and 7 (25%) had acute tubulitis on the one-week biopsy. Of the 277 kidney biopsies, there was one (0.4%) serious hemorrhagic complication, in a patient receiving low molecular weight heparin; she ultimately recovered and has normal renal function. Her biopsy showed Banff 1B tubulitis. In patients with stable or improving renal allograft function early after transplantation, subclinical tubulitis may be present in a substantial number of patients. This suggests that the true incidence of rejection may be higher than is clinically appreciated.

Original languageEnglish (US)
Pages (from-to)47-50
Number of pages4
JournalAmerican Journal of Transplantation
Volume1
Issue number1
DOIs
StatePublished - May 1 2001

Fingerprint

Transplants
Kidney
Biopsy
Incidence
Kidney Transplantation
Delayed Graft Function
Transplantation
Pancreas Transplantation
Living Donors
Low Molecular Weight Heparin
Allografts

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Shapiro, Ron ; Randhawa, Parmjeet ; Jordan, Mark L. ; Scantlebury, Velma P. ; Vivas, Carlos ; Jain, Ashok ; Corry, Robert J. ; McCauley, Jerry ; Johnston, James ; Donaldson, Joseph ; Gray, Edward A. ; Dvorchik, Igor ; Hakala, Thomas R. ; Fung, John J. ; Starzl, Thomas E. / An Analysis of Early Renal Transplant Protocol Biopsies - the High Incidence of Subclinical Tubulitis. In: American Journal of Transplantation. 2001 ; Vol. 1, No. 1. pp. 47-50.
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abstract = "To investigate the possibility that we have been underestimating the true incidence of acute rejection, we began to perform protocol biopsies after kidney transplantation. This analysis looks at the one-week biopsies. Between March 1 and October 1, 1999, 100 adult patients undergoing cadaveric kidney or kidney/pancreas transplantation, or living donor kidney transplantation, underwent 277 biopsies. We focused on the subset of biopsies in patients without delayed graft function (DGF) and with stable or improving renal function, who underwent a biopsy 8.2 ± 2.6 d (range 3-18 d) after transplantation (n = 28). Six (21{\%}) patients with no DGF and with stable or Improving renal function had borderline histopathology, and 7 (25{\%}) had acute tubulitis on the one-week biopsy. Of the 277 kidney biopsies, there was one (0.4{\%}) serious hemorrhagic complication, in a patient receiving low molecular weight heparin; she ultimately recovered and has normal renal function. Her biopsy showed Banff 1B tubulitis. In patients with stable or improving renal allograft function early after transplantation, subclinical tubulitis may be present in a substantial number of patients. This suggests that the true incidence of rejection may be higher than is clinically appreciated.",
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Shapiro, R, Randhawa, P, Jordan, ML, Scantlebury, VP, Vivas, C, Jain, A, Corry, RJ, McCauley, J, Johnston, J, Donaldson, J, Gray, EA, Dvorchik, I, Hakala, TR, Fung, JJ & Starzl, TE 2001, 'An Analysis of Early Renal Transplant Protocol Biopsies - the High Incidence of Subclinical Tubulitis', American Journal of Transplantation, vol. 1, no. 1, pp. 47-50. https://doi.org/10.1034/j.1600-6143.2001.010109.x

An Analysis of Early Renal Transplant Protocol Biopsies - the High Incidence of Subclinical Tubulitis. / Shapiro, Ron; Randhawa, Parmjeet; Jordan, Mark L.; Scantlebury, Velma P.; Vivas, Carlos; Jain, Ashok; Corry, Robert J.; McCauley, Jerry; Johnston, James; Donaldson, Joseph; Gray, Edward A.; Dvorchik, Igor; Hakala, Thomas R.; Fung, John J.; Starzl, Thomas E.

In: American Journal of Transplantation, Vol. 1, No. 1, 01.05.2001, p. 47-50.

Research output: Contribution to journalArticle

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AU - Vivas, Carlos

AU - Jain, Ashok

AU - Corry, Robert J.

AU - McCauley, Jerry

AU - Johnston, James

AU - Donaldson, Joseph

AU - Gray, Edward A.

AU - Dvorchik, Igor

AU - Hakala, Thomas R.

AU - Fung, John J.

AU - Starzl, Thomas E.

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N2 - To investigate the possibility that we have been underestimating the true incidence of acute rejection, we began to perform protocol biopsies after kidney transplantation. This analysis looks at the one-week biopsies. Between March 1 and October 1, 1999, 100 adult patients undergoing cadaveric kidney or kidney/pancreas transplantation, or living donor kidney transplantation, underwent 277 biopsies. We focused on the subset of biopsies in patients without delayed graft function (DGF) and with stable or improving renal function, who underwent a biopsy 8.2 ± 2.6 d (range 3-18 d) after transplantation (n = 28). Six (21%) patients with no DGF and with stable or Improving renal function had borderline histopathology, and 7 (25%) had acute tubulitis on the one-week biopsy. Of the 277 kidney biopsies, there was one (0.4%) serious hemorrhagic complication, in a patient receiving low molecular weight heparin; she ultimately recovered and has normal renal function. Her biopsy showed Banff 1B tubulitis. In patients with stable or improving renal allograft function early after transplantation, subclinical tubulitis may be present in a substantial number of patients. This suggests that the true incidence of rejection may be higher than is clinically appreciated.

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