M. Their et al., Fine-needle aspiration biopsy allows early detection of acute rejection inchildren after renal transplantation, TRANSPLANT, 71(6), 2001, pp. 736-743
Background. Acute rejection is still a major diagnostic problem after renal
transplantation and remains an important cause of graft loss. Diagnosis of
acute rejection is mainly based on clinical signs and the renal core biops
y findings. In adults fine-needle aspiration biopsy (FNAB) has proved to be
a sensitive method in diagnosing acute rejection.
Methods. In this study we retrospectively analyzed our data on the routine
use of FNAB after 83 kidney transplantations in 78 children of different ag
es.
Results. A total of 984 FNABs were taken during the postoperative hospitali
zation with a mean of 12 biopsies per patient. Of the biopsies 93% were rep
resentative, and no major complications occurred. Sixty-five rejection epis
odes were diagnosed and treated in 47 patients (57%). The FNAB analysis det
ected rejections often before clinical signs. Half of the patients had incr
eased serum creatinine concentration and 38% had fever at the time of rejec
tion diagnosis. Both signs were present in only 19% of the episodes. A decr
ease in urine output (> 20%) was seen in a third of the episodes. The rejec
tions responded well to oral methylprednisolone (3 mg/kg/day), and lymphogl
obulins were needed in only 12% of the episodes. More than 90% of the rejec
tions were completely reversible and no transplant was lost because of acut
e rejection.
Conclusion. The results indicate that FNAB is a safe and sensitive method f
or the diagnosis and follow-up of acute cellular rejection in pediatric rec
ipients of different ages.