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. 2022 Mar 24:35:10344.
doi: 10.3389/ti.2022.10344. eCollection 2022.

Delayed Graft Function Under the Microscope: Surveillance Biopsies in Kidney Transplantation

João Batista Saldanha De Castro Filho  1 , Jeferson De Castro Pompeo  2 , Rafael Berlezi Machado  2 , Luiz Felipe Santos Gonçalves  1   2 , Andrea Carla Bauer  1   2 , Roberto Ceratti Manfro  1   2   3
Affiliations

Delayed Graft Function Under the Microscope: Surveillance Biopsies in Kidney Transplantation

João Batista Saldanha De Castro Filho et al. Transpl Int. .

Abstract

Delayed graft function (DGF) is a common complication of kidney transplantation and frequently leads to the necessity of surveillance biopsies. The purpose of this study is to describe the histological findings in surveillance biopsies of deceased donor kidney transplant recipients and evaluate the risk factors for graft outcomes. This is a monocentric, retrospective study including kidney transplant recipients that underwent a graft biopsy during the DGF period between January 2006 and July 2019. 356 biopsies were performed in 335 deceased donor transplant recipients. Biopsies were analyzed according to the Banff classification. The main histological findings were: acute tubular necrosis in 150 biopsies (42.1%), acute rejection in 96 biopsies (26.9%), and borderline findings in 91 biopsies (25.5%). In the multivariate analysis, recipient age (p = 0.028) and DGF duration (p = 0.005) were associated with rejection, antibody-induction with anti-thymocyte globulin (ATG) was protective (p = 0.001). The occurrence of rejection was associated with lower death-censored graft survival (log-rank; p = 0.009). Surveillance biopsies of kidney grafts experiencing DGF remain an essential tool for the care of kidney transplant recipients. The recipient's age and duration of DGF are independent risk factors for acute rejection, while antibody-induction therapy with ATG is associated with protection from its occurrence.

Keywords: acute rejection; delayed graft function; immunosuppression; renal biopsy; renal transplantation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study outflow.
FIGURE 2
FIGURE 2
Histological diagnosis in surveillance biopsies of kidney transplant recipients with delayed graft function. ATN, acute tubular necrosis; AR, acute rejection; BL, borderline findings; CN, cortical necrosis; PyN, pyelonephritis; TMA, thrombotic microangiopathy.
FIGURE 3
FIGURE 3
Banff classification of rejection in kidney transplant recipients with delayed graft function. ABMR, antibody mediated acute rejection.
FIGURE 4
FIGURE 4
Kaplan-Meier survival curves. (A) Death-censored graft survival according to the occurrence of acute rejection in the surveillance biopsy; (B) Death-censored graft survival according to the use and type of antibody-induction therapy.
See this image and copyright information in PMC

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