SEQUENTIAL PROTOCOL BIOPSIES IN RENAL-TRANSPLANT PATIENTS - CLINICOPATHOLOGICAL CORRELATIONS USING THE BANFF SCHEMA

Twenty-five renal transplant patients on a triple immunosuppressive re gimen of cyclosporine, azathioprine, and prednisone underwent protocol graft biopsies at 1, 2, 3, 6, and 12 months after transplant regardle ss of renal function, The histological diagnosis was made with the Ban ff schema, As reported previously, protocol biopsies revealed a high p revalence of subclinical rejection, as well as ''borderline'' inflamma tion, despite levels of CsA considered to be in the therapeutic range, Every biopsy was given a score for the severity of the histological c hanges (the Banff Score for Inflammatory Changes [BSI]), which permitt ed the generation of a cumulative BSI over the year of follow-up for e ach patient. At the end of 1 year, normal histology and excellent rena l function (mean serum creatinine <110 mu mol/L) were seen only in tra nsplant patients with the lowest cumulative BSI (P<0.001). These resul ts suggest that repeated inflammation in the renal allograft, even if subclinical, can lead to its dysfunction. Moreover, it would appear th at, at least for the present, protocol biopsies may be required to ass ess adequately the effectiveness of current immunosuppressive therapie s in renal transplant patients.