Rajil Mehta1, Wida Cherikh2, Puneet Sood1, Sundaram Hariharan1. 1. Division of Renal and Electrolytes and Division of Transplant Surgery, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 2. United Network of Organ Sharing, Richmond, VA, USA.
Abstract
BACKGROUND: The approach to the diagnosis and management of subclinical rejection (SCR) in kidney transplant recipients remains controversial. METHODS: We conducted a survey through UNOS across US transplant centers regarding their approach to surveillance biopsies and reasons for the nonperformance of surveillance biopsies. RESULTS: Responses were obtained from 106/238 centers (45%), and only 18 (17%) of the centers performed surveillance biopsies on all patients and 22 (21%) performed biopsy for select cases. The most common time points for surveillance biopsies were 3 and 12 months post-transplant. The common reasons for not performing biopsies were low yield (n = 44, 65%) and the belief that it will not change outcome (n = 24, 36%). The incidence of SC-TCMR was ≥ 10% among 39% of centers. The mean serum creatinine was slightly worse by 0.06 mg/dL at 1 year and 0.07 mg/dL at 3 years among centers performing biopsy, P < .0001. The. 1-and 3-year Observed-Expected (O-E) graft survival was similar among centers performing biopsies vs. those not performing biopsy (P = .07, .88). CONCLUSION: Only 17% of US centers perform surveillance biopsies, with another 21% performing surveillance biopsies in select cases (among centers that responded to the survey). Greater uniformity in the approach and management of this condition is of paramount importance.
BACKGROUND: The approach to the diagnosis and management of subclinical rejection (SCR) in kidney transplant recipients remains controversial. METHODS: We conducted a survey through UNOS across US transplant centers regarding their approach to surveillance biopsies and reasons for the nonperformance of surveillance biopsies. RESULTS: Responses were obtained from 106/238 centers (45%), and only 18 (17%) of the centers performed surveillance biopsies on all patients and 22 (21%) performed biopsy for select cases. The most common time points for surveillance biopsies were 3 and 12 months post-transplant. The common reasons for not performing biopsies were low yield (n = 44, 65%) and the belief that it will not change outcome (n = 24, 36%). The incidence of SC-TCMR was ≥ 10% among 39% of centers. The mean serum creatinine was slightly worse by 0.06 mg/dL at 1 year and 0.07 mg/dL at 3 years among centers performing biopsy, P < .0001. The. 1-and 3-year Observed-Expected (O-E) graft survival was similar among centers performing biopsies vs. those not performing biopsy (P = .07, .88). CONCLUSION: Only 17% of US centers perform surveillance biopsies, with another 21% performing surveillance biopsies in select cases (among centers that responded to the survey). Greater uniformity in the approach and management of this condition is of paramount importance.
Authors: Michael E Seifert; Megan V Yanik; Daniel I Feig; Vera Hauptfeld-Dolejsek; Elizabeth C Mroczek-Musulman; David R Kelly; Frida Rosenblum; Roslyn B Mannon Journal: Am J Transplant Date: 2018-06-27 Impact factor: 8.086
Authors: Chethan M Puttarajappa; Rajil B Mehta; Mark S Roberts; Kenneth J Smith; Sundaram Hariharan Journal: Am J Transplant Date: 2020-07-15 Impact factor: 8.086
Authors: Michael E Seifert; Gaurav Agarwal; Miriam Bernard; Ellen Kasik; S Sikandar Raza; Huma Fatima; Robert S Gaston; Vera Hauptfeld-Dolejsek; Bruce A Julian; Clifton E Kew; Vineeta Kumar; Shikha Mehta; Song Ong; Frida Rosenblum; Graham Towns; Roslyn B Mannon Journal: Transplant Direct Date: 2021-01-26
Authors: Itunu Owoyemi; Srijan Tandukar; Dana R Jorgensen; Christine M Wu; Puneet Sood; Chethan Puttarajappa; Akhil Sharma; Nirav A Shah; Parmjeet Randhawa; Michele Molinari; Amit D Tevar; Rajil B Mehta; Sundaram Hariharan Journal: Transplant Direct Date: 2021-06-08