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Abstract : Renal transplantation is the treatment of choice for most patients with end stage renal disease., renal biopsy is the gold standard to assess the causes of renal allograft dysfunction. This study was designed to evaluate and designate renal lesions according to Banff schema and to determine the safety and efficacy of the practice of renal allograft biopsy and verify its impact on the management of kidney transplant patients presenting with graft dysfunction and its correlation with graft survival and clinic-biochemical parameters. In this cross-sectional study, all renal allograft biopsies obtained from renal transplant patients at Baghdad teaching hospital in Iraq during 2013-2014 were studied. Evaluations were made according to the Banff classification 2009. Clinical and biochemical data and pathological reports were collected and analyzed using SPSS analysis method. We studied 55 renal allograft biopsies of 55 adult patients (61.8% males, 38.2%females) mean age was 32.4 years, performed in the medical city complex from February 2013 to May 2014. All the biopsies were performed with a guidance of ultrasound. The procedure, complications, histological diagnoses and impact of the biopsy data on patients' management were recorded. Thirty percent of the biopsies were performed in the first 12 months post-transplantation and 70 % were performed after the 60th month. Adequate biopsy was achieved in 90.9% of the patients. Acute rejection was diagnosed in 36.4% of the biopsies and chronic allograft Nephropathy in 41%, and they were the most common histological patterns in the study. The commonest causes of graft dysfunction after kidney transplant were IF/TA. Living donors were found to be important sources for kidney transplantation in Iraq. Allograft biopsy was a useful and a relatively safe tool for the diagnosis of acute and chronic graft dysfunction in our experience, since there were no major complications and minor complications were rare and with negligible consequences. This procedure using 16-gauge needles also is efficient, as the majority of samples were adequate for diagnostic purposes. None specified symptoms allow for clear differentiation between stable transplants with normal histology and stable transplants with subclinical rejection. Therefore, the protocol allograft biopsy currently remains the preferred tool to screen for subclinical transplant injury. A protocol biopsy is an excellent method for the early diagnosis of disorders in the transplanted kidney and to monitor the effects of immunosuppression. The protocol biopsy, followed by appropriate treatment, promotes preservation of kidney allograft function and therefore improves long-term graft survival.

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