Protocol biopsy monitored therapy after kidney transplantation <b><i>versus</i></b> conventional therapy: a systematic review and Meta-analysis _West China Medical Journal

Authors：

ZHANG Ruochen ^1,2 , LIU Zhihong ¹ , TANG Liangyou ¹ , ZOU Zijun ¹ , JIANG Liang ¹ , WANG Yujie ¹ , LIANG Jiayu ¹ , TANG Yongquan ¹ ,  LU Yiping ¹

1. Department of Urology / Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Urology, Fujian Medical University Teaching Hospital / Fujian Provincial Hospital, Fuzhou, Fujian 350001, P. R. China;

Corresponding author：

LU Yiping, Email: yipinglu@163.com

Keywords：

Kidney transplantation; Renal biopsy; Protocol biopsy; Clinical effect

DOI：

10.7507/1002-0179.201603300

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ObjectiveTo conduct a Meta-analysis to determine the clinical effect of protocol biopsy (PB)-monitored therapy after renal transplantation.MethodsPubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Standards Database and VIP Database for Chinese Technical Periodicals were searched for trials comparing the efficacy of timely intervention under PB surveillance with the conventional treatment. The quality of included studies was assessed and Meta-analysis was conducted by RevMan 5.3 software.ResultsSix randomized controlled trials met our inclusion criteria, including 698 cases. No significant difference was found between the PB group and the control group in 1-year [relative risk (RR)=0.99, 95% confidence interval (CI) (0.97, 1.01), P=0.39] and 2-year recipient survival rate [RR=1.00, 95%CI (0.97, 1.02), P=0.72]. Graft survival rate after 1 year [RR=1.01, 95%CI (0.99, 1.04), P=0.29] and 2 years [RR=1.02, 95%CI (0.99, 1.06), P=0.19] were also statistically similar. No statistical difference was found in glomerular filtration rate between the two groups [mean difference (MD)=0.45 mL/(min·1.73 m²), 95%CI (–3.77, 4.67) mL/(min·1.73 m²), P=0.83]. Renal function of PB group, monitored by serum creatinine, was superior to the control group [MD=–0.46 mg/dL, 95%CI (–0.63, –0.29) mg/dL, P<0.000 01]. No statistical difference was found in infection between the two groups [RR=1.23, 95%CI (0.69, 2.19), P=0.48].ConclusionsOur study did not suggest PB for every kidney transplantation recipient. However, long-term randomized controlled trials with larger sample size would be necessary to determine whether PB was effective for specific populations.

Citation： ZHANG Ruochen, LIU Zhihong, TANG Liangyou, ZOU Zijun, JIANG Liang, WANG Yujie, LIANG Jiayu, TANG Yongquan, LU Yiping. Protocol biopsy monitored therapy after kidney transplantation versus conventional therapy: a systematic review and Meta-analysis . West China Medical Journal, 2018, 33(7): 869-876. doi: 10.7507/1002-0179.201603300 Copy

1.	Szederkényi E, Iványi B, Morvay Z, et al. Treatment of subclinical injuries detected by protocol biopsy improves the long-term kidney allograft function: a single center prospective randomized clinical trial. Transplant Proc, 2011, 43(4): 1239-1243.
2.	Chapman JR, Nankivell BJ. Nephrotoxicity of ciclosporin A: short-term gain, long-term pain?. Nephrol Dial Transplant, 2006, 21(8): 2060-2063.
3.	Krejci K, Tichy T, Al-Gabri S, et al. Protocol biopsy of a transplanted kidney as a tool for monitoring adequacy of immunosuppressive therapy: 10 years of experience from a single transplant center. Transplant Proc, 2011, 43(5): 1576-1582.
4.	Serón D, Moreso F, Fulladosa X, et al. Reliability of chronic allograft nephropathy diagnosis in sequential protocol biopsies. Kidney Int, 2002, 61(2): 727-733.
5.	Sharif A, Alachkar N, Bagnasco S, et al. Incidence and outcomes of BK virus allograft nephropathy among ABO- and HLA-incompatible kidney transplant recipients. Clin J Am Soc Nephrol, 2012, 7(8): 1320-1327.
6.	Servais A, Meas-Yedid V, Toupance O, et al. Interstitial fibrosis quantification in renal transplant recipients randomized to continue cyclosporine or convert to sirolimus. Am J Transplant, 2009, 9(11): 2552-2560.
7.	Furness PN, Philpott CM, Chorbadjian MT, et al. Protocol biopsy of the stable renal transplant: a multicenter study of methods and complication rates. Transplantation, 2003, 76(6): 969-973.
8.	Schwarz A, Gwinner W, Hiss M, et al. Safety and adequacy of renal transplant protocol biopsies. Am J Transplant, 2005, 5(8): 1992-1996.
9.	Rush D, Nickerson P, Gough J, et al. eneficial effects of treatment of early subclinical rejection: a randomized study. J Am Soc Nephrol, 1998, 9(11): 2129-2134.
10.	Gotti E, Perico N, Perna A, et al. Renal transplantation: can we reduce calcineurin inhibitor/ stop steroids? Evidence based on protocol biopsy findings. J Am Soc Nephrol, 2003, 14(3): 755-766.
11.	Rush D, Arlen D, Busque S, et al. Lack of benefit of early protocol biopsies in renal transplant patients receiving TAC and MMF: a randomized study. Am J Transplant, 2007, 7(11): 2538-2545.
12.	Kurtkoti J, Sakhuja V, Sud K, et al. The utility of 1- and 3-month protocol biopsies on renal allograft function: a randomized controlled study. Am J Transplant, 2008, 8(2): 317-323.
13.	Guleria S, Jain S, Dinda AK, et al. The short-term impact of protocol biopsies in a live-related renal transplant program using tacrolimus based immunosuppression. Indian J Nephrol, 2013, 23(4): 253-258.
14.	Henderson LK, Nankivell BJ, Chapman JR. Surveillance protocol kidney transplant biopsies: their evolving role in clinical practice. Am J Transplant, 2011, 11(8): 1570-1575.
15.	Choi BS, Shin MJ, Shin SJ, et al. Clinical significance of an early protocol biopsy in living-donor renal transplantation: ten-year experience at a single center. Am J Transplant, 2005, 5(6): 1354-1360.
16.	Kee TY-S, Chapman JR, O’Connell PJ, et al. Treatment of subclinical rejection diagnosed by protocol biopsy of kidney transplants. Transplantation, 2006, 82(1): 36-42.
17.	Mao Y, Chen J, Shou Z, et al. Clinical significance of protocol biopsy at one month posttransplantation in deceased-donor renal transplantation. Transpl Immunol, 2007, 17(3): 211-214.
18.	Nankivell B, Chapman J: The significance of subclinical rejection and the value of protocol biopsies. Am J Transplant, 2006, 6(9): 2006-2012.
19.	Nankivell BJ, Borrows RJ, Fung CL-S, et al. Calcineurin inhibitor nephrotoxicity: longitudinal assessment by protocol histology. Transplantation, 2004, 78(4): 557-565.
20.	Furness PN, Philpott CM, Chorbadjian MT, et al. Protocol biopsy of the stable renal transplant: a multicenter study of methods and complication rates. Transplantation, 2003, 76(6): 969-973.
21.	Rush D: Can protocol biopsy better inform our choices in renal transplantation?. Transplant Proc, 2009, 41(6 Suppl): S6-S8.
22.	Maripuri S, Penson DF, Ikizler TA, et al. Outpatient versus inpatient observation after percutaneous native kidney biopsy: a cost minimization study. Am J Nephrol, 2011, 34(1): 64-70.
23.	Al-Hweish A, Abdul-Rehaman I. Outpatient percutaneous renal biopsy in adult patients. Saudi J Kidney Dis Transpl, 2007, 18(4): 541-546.

1. Szederkényi E, Iványi B, Morvay Z, et al. Treatment of subclinical injuries detected by protocol biopsy improves the long-term kidney allograft function: a single center prospective randomized clinical trial. Transplant Proc, 2011, 43(4): 1239-1243.
2. Chapman JR, Nankivell BJ. Nephrotoxicity of ciclosporin A: short-term gain, long-term pain?. Nephrol Dial Transplant, 2006, 21(8): 2060-2063.
3. Krejci K, Tichy T, Al-Gabri S, et al. Protocol biopsy of a transplanted kidney as a tool for monitoring adequacy of immunosuppressive therapy: 10 years of experience from a single transplant center. Transplant Proc, 2011, 43(5): 1576-1582.
4. Serón D, Moreso F, Fulladosa X, et al. Reliability of chronic allograft nephropathy diagnosis in sequential protocol biopsies. Kidney Int, 2002, 61(2): 727-733.
5. Sharif A, Alachkar N, Bagnasco S, et al. Incidence and outcomes of BK virus allograft nephropathy among ABO- and HLA-incompatible kidney transplant recipients. Clin J Am Soc Nephrol, 2012, 7(8): 1320-1327.
6. Servais A, Meas-Yedid V, Toupance O, et al. Interstitial fibrosis quantification in renal transplant recipients randomized to continue cyclosporine or convert to sirolimus. Am J Transplant, 2009, 9(11): 2552-2560.
7. Furness PN, Philpott CM, Chorbadjian MT, et al. Protocol biopsy of the stable renal transplant: a multicenter study of methods and complication rates. Transplantation, 2003, 76(6): 969-973.
8. Schwarz A, Gwinner W, Hiss M, et al. Safety and adequacy of renal transplant protocol biopsies. Am J Transplant, 2005, 5(8): 1992-1996.
9. Rush D, Nickerson P, Gough J, et al. eneficial effects of treatment of early subclinical rejection: a randomized study. J Am Soc Nephrol, 1998, 9(11): 2129-2134.
10. Gotti E, Perico N, Perna A, et al. Renal transplantation: can we reduce calcineurin inhibitor/ stop steroids? Evidence based on protocol biopsy findings. J Am Soc Nephrol, 2003, 14(3): 755-766.
11. Rush D, Arlen D, Busque S, et al. Lack of benefit of early protocol biopsies in renal transplant patients receiving TAC and MMF: a randomized study. Am J Transplant, 2007, 7(11): 2538-2545.
12. Kurtkoti J, Sakhuja V, Sud K, et al. The utility of 1- and 3-month protocol biopsies on renal allograft function: a randomized controlled study. Am J Transplant, 2008, 8(2): 317-323.
13. Guleria S, Jain S, Dinda AK, et al. The short-term impact of protocol biopsies in a live-related renal transplant program using tacrolimus based immunosuppression. Indian J Nephrol, 2013, 23(4): 253-258.
14. Henderson LK, Nankivell BJ, Chapman JR. Surveillance protocol kidney transplant biopsies: their evolving role in clinical practice. Am J Transplant, 2011, 11(8): 1570-1575.
15. Choi BS, Shin MJ, Shin SJ, et al. Clinical significance of an early protocol biopsy in living-donor renal transplantation: ten-year experience at a single center. Am J Transplant, 2005, 5(6): 1354-1360.
16. Kee TY-S, Chapman JR, O’Connell PJ, et al. Treatment of subclinical rejection diagnosed by protocol biopsy of kidney transplants. Transplantation, 2006, 82(1): 36-42.
17. Mao Y, Chen J, Shou Z, et al. Clinical significance of protocol biopsy at one month posttransplantation in deceased-donor renal transplantation. Transpl Immunol, 2007, 17(3): 211-214.
18. Nankivell B, Chapman J: The significance of subclinical rejection and the value of protocol biopsies. Am J Transplant, 2006, 6(9): 2006-2012.
19. Nankivell BJ, Borrows RJ, Fung CL-S, et al. Calcineurin inhibitor nephrotoxicity: longitudinal assessment by protocol histology. Transplantation, 2004, 78(4): 557-565.
20. Furness PN, Philpott CM, Chorbadjian MT, et al. Protocol biopsy of the stable renal transplant: a multicenter study of methods and complication rates. Transplantation, 2003, 76(6): 969-973.
21. Rush D: Can protocol biopsy better inform our choices in renal transplantation?. Transplant Proc, 2009, 41(6 Suppl): S6-S8.
22. Maripuri S, Penson DF, Ikizler TA, et al. Outpatient versus inpatient observation after percutaneous native kidney biopsy: a cost minimization study. Am J Nephrol, 2011, 34(1): 64-70.
23. Al-Hweish A, Abdul-Rehaman I. Outpatient percutaneous renal biopsy in adult patients. Saudi J Kidney Dis Transpl, 2007, 18(4): 541-546.

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