AUTHOR=Namba-Hamano Tomoko , Hamano Takayuki , Doi Yohei , Hiraoka Atsuko , Yonishi Hiroaki , Sakai Shinsuke , Takahashi Atsushi , Mizui Masayuki , Nakazawa Shigeaki , Yamanaka Kazuaki , Kakuta Yoichi , Imamura Ryoichi , Nonomura Norio , Isaka Yoshitaka TITLE=Clinical Impacts of Allograft Biopsy in Renal Transplant Recipients 10 Years or Longer After Transplantation JOURNAL=Transplant International VOLUME=37 YEAR=2024 URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2024.13022 DOI=10.3389/ti.2024.13022 ISSN=1432-2277 ABSTRACT=

We aimed to investigate the clinical value of allograft biopsy performed long after renal transplantation. We retrospectively evaluated 99 allograft biopsies in recipients with transplantation vintages of 10 years or longer. Mixed-effects model showed that 1-year estimated glomerular filtration rate (eGFR) slopes after biopsy were significantly greater than those before biopsy [−3.13, −4.42 mL/min/1.73 m2/year, p = 0.01]. Renal biopsy changed the treatment strategies in more than half of the patients. Improvement in eGFR slopes was pronounced in 51 patients with treatment modification based on the biopsy results [2.27 (95% confidence interval (CI): 0.66, 3.89) mL/min/1.73 m2/year], whereas no improvement was observed in those without [0.33 (95% CI: −1.05, 1.71) mL/min/1.73 m2/year, Pinteraction = 0.001]. Among the treatment modifications, enhancement of immunosuppression (IS) led to the most remarkable improvement in eGFR slope. Patients with g scores ≥2 were more likely to receive IS enhancement than those with g scores = 0 [odds ratio; 15.0 (95% CI: 1.65, 136)]. Patients with active glomerulitis (g ≥ 1) without chronicity (cg ≤ 1) showed the most significant improvement in eGFR slope. Given the prevalence of active glomerulitis (g ≥ 1, 21%), which is responsive to treatment even long after transplantation, and the observed magnitude of eGFR slope improvement, renal biopsy can indeed improve allograft prognosis.