دورية أكاديمية
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Early surveillance biopsy utilization and management of pediatric renal allograft acute T cell-mediated rejection in Canadian centers: Observations from the PROBE multicenter cohort study.

التفاصيل البيبلوغرافية
العنوان: Early surveillance biopsy utilization and management of pediatric renal allograft acute T cell-mediated rejection in Canadian centers: Observations from the PROBE multicenter cohort study.
المؤلفون: Hoffmann AJ; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada., Gibson IW; Department of Pathology, University of Manitoba, Winnipeg, MB, Canada., Ho J; Department of Medicine, University of Manitoba, Winnipeg, MB, Canada., Nickerson P; Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.; Shared Health Services Manitoba, Transplant/Immunology Lab, Winnipeg, MB, Canada., Rush D; Department of Medicine, University of Manitoba, Winnipeg, MB, Canada., Sharma A; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada., Wishart D; The Metabolomics Innovation Centre, University of Alberta, Edmonton, AB, Canada., Blydt-Hansen TD; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
المصدر: Pediatric transplantation [Pediatr Transplant] 2021 Mar; Vol. 25 (2), pp. e13870. Date of Electronic Publication: 2020 Oct 07.
نوع المنشور: Journal Article; Multicenter Study; Observational Study
اللغة: English
بيانات الدورية: Publisher: Munksgaard Country of Publication: Denmark NLM ID: 9802574 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1399-3046 (Electronic) Linking ISSN: 13973142 NLM ISO Abbreviation: Pediatr Transplant Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Copenhagen ; Malden, MA : Munksgaard, c1997-
مواضيع طبية MeSH: Kidney Transplantation*, Aftercare/*methods , Graft Rejection/*diagnosis , Graft Rejection/*therapy , Healthcare Disparities/*statistics & numerical data , Kidney/*pathology , Practice Patterns, Physicians'/*statistics & numerical data, Acute Disease ; Adolescent ; Aftercare/standards ; Aftercare/statistics & numerical data ; Biopsy ; Canada ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Graft Rejection/immunology ; Graft Rejection/pathology ; Humans ; Infant ; Infant, Newborn ; Kidney/immunology ; Male ; Prospective Studies ; T-Lymphocytes ; Young Adult
مستخلص: Background: Early TCMR surveillance with protocol kidney biopsy is used differentially among pediatric kidney transplant centers. Little has been reported about actual center-based differences, and this variability may influence TCMR ascertainment, treatment, and monitoring more broadly.
Methods: Data from the PROBE multicenter study were used to identify patients from centers conducting ESB or LSIB. ESB was defined as >50% of patients having at least 1 surveillance biopsy in the first 9 months. Patients were compared for number of biopsies, rejection episodes, treatment, and follow-up monitoring.
Results: A total of 261 biopsies were performed on 97 patients over 1-2 years of follow-up. A total of 228 (87%) of biopsies were performed in ESB centers. Compared to LSIB centers, ESB centers had 7-fold more episodes of TCMR diagnosed on any biopsy [0.8 ± 1.2 vs 0.1 ± 0.4; P < .001] and a 3-fold higher rate from indication biopsies [0.3 ± 0.9 vs 0.1 ± 0.3; P = .04]. The proportion of rejection treatment varied based on severity: Banff borderline i1t1 (40%);>i1t1 and < Banff 1A (86%); and ≥ Banff 1A (100%). Biopsies for follow-up were performed after treatment in 80% of cases (n = 28) of rejection almost exclusively at ESB centers, with 17 (61%) showing persistence of TCMR (≥i1t1).
Conclusions: Practice variation exists across Canadian pediatric renal transplant centers with ESB centers identifying more episodes of rejection. Additionally, treatment of Banff borderline is not universal and varies with severity regardless of center type. Lastly, follow-up biopsies are performed inconsistently and invariably show persistence of rejection.
(© 2020 Wiley Periodicals LLC.)
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معلومات مُعتمدة: 274755 Canada CIHR; 340137 Canada CIHR
فهرسة مساهمة: Keywords: T-cell; follow-up biopsy; kidney; mediated rejection; pediatrics; protocol biopsy; renal; surveillance; transplant
تواريخ الأحداث: Date Created: 20201007 Date Completed: 20220104 Latest Revision: 20220104
رمز التحديث: 20231215
DOI: 10.1111/petr.13870
PMID: 33026135
قاعدة البيانات: MEDLINE
الوصف
تدمد:1399-3046
DOI:10.1111/petr.13870