Surveillance biopsy detects nearly half of early rejections in living donor kidney transplants: an observational study from Nepal.

backgroundProtocol biopsies (PBs) are done at different time points after organ transplantation to explore any signs of damage to the allograft without manifesting clinically. There are no consensus guidelines on use of protocol biopsies or specific time points to perform a PBs after kidney transplantation but literature suggests that findings of PBs may be a guide to long term graft outcomes. It is specially important to know whether such interventions are worth undertaking in the developing world where patients pay for healthcare. We studied the results of PBs done in living donor kidney transplant (LDKT) in our centre, to explore the frequency of various clinical conditions that could be detected by PBs.

methodsWe collected the reports of PBs done after completion of 6 months of kidney transplant surgery. Among the 203 patients who had LDKT done between 27 Oct 2021 and 29 May 2024, 119 underwent PB. Nineteen others had indication biopsy and 65 didn't have biopsy at all. We collected and entered relevant information to Microsoft Excel and performed descriptive analysis.

resultsRejection rates in our transplant population in the first year after transplant was 5.41%. Of these rejections, 45.45% were detected by PBs. Subclinical rejection (SCR) was seen in 2.46% of all transplants and 4.20% of all PBs. Glomerulonephritis and BK polyomavirus associated nephropathy were detected in 15.96% and 5.04% of all PBs. However, renal tissue injury was the most common finding detected in 21.01% of all PBs.

conclusionSurveillance biopsies have important implications for detection of subtle allograft damage which would otherwise unknowingly damage the allograft and lead to irreversible graft loss.