The value of graft biopsy in the management of renal transplant patients

Premise: This report emphasizes the importance of renal allograft biopsy in the diagnosis and therapy of transplant dysfunction. Review of the literat ure demonstrates that renal allograft biopsy is the "gold standard" for det ermining the cause of graft dysfunction. Despite this, some transplant cent ers are reluctant to perform graft biopsies at the onset of renal dysfuncti on. Instead, the initial response to graft dysfunction is empiric steroid t herapy or adjustment in cyclosporine or tacrolimus dosage. In this study, w e retrospectively reviewed the charts of 55 renal transplant patients at ou r transplant center (mean age, 41 years) having undergone a total of 97 bio psies because of post-transplant dysfunction. In most cases, the transplant surgeon performed renal transplant biopsies during episodes of renal graft : dysfunction after therapy was initiated. Findings: The renal transplant biopsy results caused a change in treatment in 83% of episodes in which treatment for graft dysfunction was initiated b efore biopsy. The changes in treatment ranged from substantial (starting or stopping anti-rejection medications) in 52% of episodes to moderate (adjus tments in medication doses) in 31% of episodes. Conclusions: We conclude that renal biopsy is essential for establishing th e correct cause of renal allograft dysfunction and subsequent post-transpla nt management. Although no single study has been large enough to be statist ically significant in demonstrating the inability to clinically determine t he cause of acute allograft dysfunction, taken in the aggregate, the clinic al impression is inescapable. Thus, biopsy should precede any therapeutic i ntervention in patients with post-transplant graft dysfunction.