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Protokollbiopsie nach Nierentransplantation

Wissenschaftliches Interesse oder notwendige Frühdiagnostik?

Protocol biopsy after renal transplantation

Just a research tool or essential for routine diagnostics?

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Protokollbiopsien nach Nierentransplantation haben in den letzten Jahren eine zunehmende Verbreitung gefunden. Den Risiken einer zusätzlichen Biopsie ohne klinische Indikation steht der Nutzen des frühzeitigen Erkennens subklinisch ablaufender Krankheitsprozesse gegenüber. Umfangreiche Daten von mehreren Protokollbiopsieprogrammen implizieren, dass früh nach Transplantation subklinisch ablaufende immunologische und nichtimmunologische Schädigungsprozesse mit dem späteren Auftreten von chronisch-irreversiblen Transplantatschäden assoziiert sind. Dies trifft vor allem auf immunologische Hochrisikopatienten zu. Basierend auf diesen Erkenntnissen muss nun klinisch die Hypothese validiert werden, dass eine frühzeitige adäquate Therapie dieser subklinischen Schädigungen zu einer Verbesserung der Langzeitfunktion nach Nierentransplantation beiträgt. Protokollbiopsien sind hierfür ein essenzielles Instrument.

Abstract

Protocol biopsies after renal transplantation have recently experienced a broader application in an increasing number of transplant centres. However, the risks of an additional, not clinically indicated biopsy must be justified by the chance of improving long-term allograft survival by more timely detection and therapeutic intervention in cases of subclinical pathologies. Robust data from several transplant centres routinely doing protocol biopsies indicate strong associations between early subclinical immunological and nonimmunological allograft injury and the later onset of chronic, irreversible allograft damage. This is especially crucial in immunologically high-risk patients. Based on these data, the hypothesis that early therapeutic intervention in cases with subclinical pathologies will improve long-term function after renal transplantation must be clinically validated. To this end, protocol biopsies are the essential tool.

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Authors and Affiliations

  1. Alberta Transplant Applied Genomics Centre,Division of Nephrology & Immunology, University of Alberta, #250 Heritage Medical Research Centre, T6G 2S2, Edmonton, Alberta, Canada

    M. Mengel

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  1. M. Mengel
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Correspondence to M. Mengel.

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Mengel, M. Protokollbiopsie nach Nierentransplantation. Nephrologe 3, 216–221 (2008). https://doi.org/10.1007/s11560-008-0148-9

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  • DOI: https://doi.org/10.1007/s11560-008-0148-9

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