BENEFIT OF PROTOCOL BIOPSIES OF TRANSPLANT KIDNEYS FOR EVALUATION OF THE EFFICIENCY OF IMMUNOSUPPRESSIVE THERAPY.

Abstract

A146 Aims: The goal of this study was to evaluate the benefit of protocol biopsies of grafts in our own file of patient who underwent transplantation, in order to monitor the adequacy of immunosuppression, subclinical rejection and subclinical nephrotoxic damage to the transplanted kidney. Methods: 43 protocol biopsies have been performed in the 3rd week, 41 biopsies in the 3rd month and 26 biopsies in the 12th month after transplantation on a file of 43 patients after transplantation of cadaver kidney, with an average age of 51.4 years, who were treated with a combination of cyclosporin A, azathioprine or mycophenolate mofetil and prednisone. Histological evaluation was performed according to the Banff 97 classification. Subclinical rejection was defined as a histological finding of rejection infiltration with the IA extent and with a normal (serum creatinine up to 120 umol/l), stabilized function of the graft in the same time. Results: Subclinical rejection was found in 8 patients (18,6%) in biopsies of the 3rd week, in 11 patients (26,8%) in biopsies performed in the 3rd month after transplantation and in 2 individuals (7,7%) one year after the transplantation. Signs of nephrotoxicity were detected in 9 patients (20,9%) in biopsies of the 3rd week, in 15 patients (36,6%) in biopsies performed 3 months after transplantation and in 9 individuals (34,6%) one year after transplantation. Conclusions: We have verified a high percentage of subclinical acute rejection and subclinical nephrotoxicity of calcineurin antagonists in early protocol biopsies of the transplant kidneys. Protocol biopsy is a method of choice to control the efficiency of immunosuppressive therapy.