Can Pre-Implantation Biopsies Predict Renal Allograft Function in Paediatric Renal Transplant Recipients?

Abstract

Introduction: Pre-implantation renal transplant biopsies are a valuable tool in delineating objective information about the donor organ, which can be important in understanding the aetiology of chronic changes subsequently in renal transplant biopsies. We aim to determine the utility of pre-implantation biopsies to predict long term renal allograft outcome in paediatric renal transplant recipients (RTR). Method: Single centre retrospective review performed on all patients who underwent pre-implantation renal transplant biopsies from 2003 to 2011 with evaluation of the clinical characteristics of recipients, the presence of delayed graft function (DGF) and renal allograft function in the immediate and subsequent post-transplantation period. Results: 32 (57% male) patients aged 1.5 - 16 (median 10.2) years of whom 56% received deceased donor renal transplants (DD) and had pre-implantation biopsies performed during the study period with follow-up of 6 to 78 (median 33) months. The characteristics between DD and living donors (LD) were similar with donor age of 30 - 50 (median 41.3) and 34 - 51 (median 45.3) years. There was no significant difference between the histological findings of LD and DD. 47% (15) of biopsies were reported as showing minor chronic vascular changes while three were reported with moderate to severe vascular changes. 9% of patients displayed DGF and 21% had acute rejection episodes. The presence of pre-existing vascular changes did not appear to be related to DGF. No correlation was observed between renal allograft function and the presence of minor vascular changes at 3, 6 and 12 months post transplant. Discussion: 46% of pre-implantation renal transplant biopsies displayed minor vascular changes. These minor histological changes did not show major impact on subsequent renal allograft function in paediatric RTR but helped delineate changes which could be of donor or recipient origin. We would recommend the routine practice of pre-implantation biopsies in children, which provides important baseline information of the graft with implications on the subsequent medical treatment for paediatric RTR.