To biopsy or not to biopsy? Should we screen the histology of stable renal grafts?

Chronic allograft dysfunction is currently the main cause of late allograft failure. Recent encouraging evidence suggests that it may be possible to delay the development of graft damages if adequate management is initiated early in the course of the disease. These observations have renewed interest in the performance of protocol biopsies as routine follow-up procedure for the screening of renal transplants. In the present review, we summarize the available data from the literature to determine the pros and cons of protocol renal allograft biopsies. On the basis of this evidence, we discuss the ethical concerns raised by this procedure.