Annual Protocol Biopsies for Five Years in a Pediatric Kidney Transplant Program: A Single-Center Retrospective Experience
Pediatric Transplantation, cilt.30, sa.9, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 30 Sayı: 9
- Basım Tarihi: 2026
- Doi Numarası: 10.1111/petr.70464
- Dergi Adı: Pediatric Transplantation
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: banff classification, kidney transplantation, pediatric, protocol biopsy, subclinical rejection, surveillance
- İstanbul Medipol Üniversitesi Adresli: Evet
Özet
Background: Annual protocol biopsies may detect subclinical injury after pediatric kidney transplantation, but real-world five-year surveillance coverage and clinical yield are uncertain. We assessed coverage, histological yield, management consequences, and histology–function associations. Methods: We conducted a retrospective cohort study of all 42 consecutive pediatric kidney transplant recipients transplanted between 2007 and 2017 and followed in a single pediatric nephrology program with annual surveillance biopsies. Analyses were based on accrued recipient-year surveillance opportunities; biopsies performed at scheduled times for a clinical indication were excluded from protocol-biopsy analyses. A random-intercept mixed-effects model related estimated glomerular filtration rate (eGFR) to a study-specific chronicity composite score and post-transplant year. Results: Of 158 accrued surveillance opportunities, a protocol biopsy was attempted at 123 (77.8%); 94/158 (59.5%) opportunities in 36 recipients yielded evaluable histology. Abnormal findings occurred in 15/94 (16.0%) evaluable results, involving 10 recipients, and 4/15 (26.7%) were followed by a documented biopsy-driven management change. Seven abnormalities in years 1–2 occurred in seven different recipients, whereas all eight abnormalities in years 3–5 were confined to three recipients with consecutive abnormal biopsies. Higher chronicity scores were associated with lower concurrent eGFR (β = −4.49 mL/min/1.73 m2 per score point; 95% CI, −7.16 to −1.82; p = 0.001). Conclusions: Real-world surveillance coverage and interpretable yield were incomplete, and documented management impact was limited. These data do not establish a benefit of uniform annual surveillance and provide a rationale for prospective evaluation of risk-adapted strategies.