Practice Patterns Surrounding Surveillance Biopsies in Pediatric Kidney Transplant Patients

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Abstract

There have been very few advancements in the long-term outcomes of children who have had a kidney transplantation in the current era of immunosuppression. Because of this, some centers have started to perform surveillance biopsies in an attempt to diagnose and potentially treat early or subclinical findings of renal allograft injury. There is very little information on the practice patterns of pediatric nephrologists regarding these biopsies. To gain a better idea of how many centers in North American are doing surveillance biopsies, we sent out a brief survey electronically via the PedNeph email list (https://lists.uchicago.edu/web/info/pedneph), with a reminder sent 4 weeks later. Of the survey respondents, currently 34.3% (23/67) perform surveillance biopsies. We were unable to determine the actual percentage of attending pediatric nephrologists who completed the survey due to 1) membership of people in the listserv who are not physicians, 2) members who are no longer practicing who are still on the list, and 3) members whose email has changed but both of their emails are on the list. We received responses from 60% (33/50) of the top 50 ranked pediatric nephrology centers in the 2016-2017 U.S. News & World Report rankings comprising 29 different states, Canada, and Europe. The majority of responding centers, 68.4% (13/19) do continuous direct sonographic guidance. Not all centers biopsied children at the same time points. 52% (12/23) of centers biopsied patients at 3mo, 69.5% (16/23) at 6 months, 78.2% (18/23) at 1 year and 43.4% (10/23) at 2 years post-transplant. Of the 19 centers that responded to this question, 12 (63.2%) observe the patient and discharge home. Eighty-two percent (18/22) centers who answered the question and perform SB said that the pediatric nephrologist does the SB, and 68.2% (15/22) use direct sonographic guidance. Sixty two percent (13/21) have someone from pathology (technician, pathologist, etc.) present in the room during the procedure to collect the tissue and examine for adequacy. All respondents stated that their complication rates were low, but most did not have specific numbers available. Having a better understanding of the practice patterns among pediatric nephrologists is critical as this is the first step in developing protocols and future research studies. More work needs to be done to examine the finding of these biopsies.

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