Puntambekar A, Parameswaran S and Nachiappa RG
Background: Renal transplant patients in JIPMER undergo a systematic post-transplant follow-up in order to identify any new co-morbidity as well as detect abnormalities in graft function at the earliest and institute appropriate management. The renal allograft biopsy is one of the principal tools used by the nephrologists to diagnose any such episodes of graft dysfunction.
Objective: The aim of this study were to identify the chief causes of end stage renal disease and co-morbid conditions, to study the number of biopsies taken for each patient as a function of time and to assess the usefulness of an allograft biopsy.
Materials & Methods: A total of 120 renal transplants were carried out in JIPMER in a period of 5 years from March 2012 to March 2017. 78 patients who underwent renal allograft biopsies were included in the study, serial measurement of serum creatinine and change in dose of immunosuppressant were recorded and correlated with the biopsy findings.
Results: In exactly two-thirds of the patients (52) the cause for ESRD (End-Stage Renal Disease) could not be determined; in the remaining 26 secondary FSGS was the leading cause for ESRD. Systemic Hypertension (59%) was found to be the major co-morbidity in renal transplant patient, 82% patients underwent renal biopsy within the first 3 months after transplant and elevation in serum creatinine was the indication for most of the biopsies. A large fraction of the patients (64%) improved upon instituting appropriate treatment measures based on biopsy findings in correlation with other clinical and laboratory data.
Conclusion: Our findings suggest that for our setting renal allograft biopsy is the major modality of diagnosing the cause for derangement in graft function, especially in the early post-transplant period. Management course decided on the basis of biopsy findings results in improved patient outcome in a majority of cases.