Vol 16, No 4 (2023)
Review paper
Published online: 2024-01-04

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The role of protocolar biopsy in the diagnosis of kidney allograft dysfunction

Łukasz Krzysztof Jankowski12, Julia Stepien12, Marcin Jurczak12, Zuzanna Sala12, Magdalena Durlik12
DOI: 10.5603/rdatf.97029
Renal Disease and Transplantation Forum 2023;16(4):127-134.


Core-needle biopsy in patients with impaired renal transplant function and histopathological evaluation of the obtained tissue samples is a recognized diagnostic method of numerous graft pathologies. Until now the use of this invasive procedure in patients with no revealed signs of transplant pathology and with a stable function of the transplanted kidney at planned intervals after transplantation (the so-called protocol biopsies) has seemed inconclusive. It is known that changes in the biopsy of the transplanted kidney are an earlier marker of transplant pathology in relation to laboratory abnormalities and the appearance of clinical symptoms, and the accumulation of subclinically progressing chronic changes is currently considered to be the main cause of renal graft loss. The histopathological evaluation also allows for the assessment of prognosis and the introduction of possible changes in the ongoing treatment. Opponents of protocol biopsy emphasize that it is an invasive procedure and exposes the patient to complications. Due to controversial reports on the usefulness of this method, protocol biopsies are not a routine tool for monitoring transplantation in transplant centers both in Poland and in the world. This review article summarizes the current state of knowledge concerning the use of protocol biopsies in the diagnosis of transplanted kidney.

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