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Nephrol Dial Transplant. 2019 Apr 1;34(4):703-711. doi: 10.1093/ndt/gfy221.

Comparison of graft and patient survival according to the transplantation centre policy for 1-year screening biopsy among stable kidney recipients: a propensity score-based study.

Author information

1
Department of Nephrology, Dialysis and Transplantation, Departmental Hospital of Vendée, La Roche-sur-Yon, France.
2
Centre de Recherche en Transplantation et Immunologie INSERM UMR1064, Université de Nantes, Centre Hospitalier Universitaire de Nantes, RTRS "Centaure", Nantes, France.
3
INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France.
4
Centre Hospitalier Universitaire de Nantes, Nantes, France.
5
IDBC/A2com, Pacé, France.
6
Department of Nephrology, Dialysis and Transplantation, Lapeyronie University Hospital, Montpellier, France.
7
Kidney Transplant Center, Necker University Hospital, APHP, RTRS "Centaure", Paris Descartes and Sorbonne Paris Cité Universities, Paris, France.
8
Department of Nephrology, Dialysis, and Organ Transplantation, Rangueil University Hospital and University Paul Sabatier, Toulouse, France.
9
Department of Renal Transplantation, Brabois University Hospital, Nancy, France.
10
Department of Nephrology, Transplantation and Clinic Immunology, RTRS "Centaure", Edouard Herriot University Hospital, Hospices Civils, Lyon, France.
11
Centre d'Investigation Clinique en Biothérapie, Labex Transplantex, Nantes, France.

Abstract

BACKGROUND:

The clinical utility of screening biopsies (SBs) at 1 year post-transplantation is still debated, especially for stable kidney graft recipients. Given the heterogeneity in practices between transplantation centres, the objective of this study was to compare graft and patient survival of stable patients according to whether they were followed up in a transplantation centre with or without a policy for having an SB at 1 year post-transplantation.

MATERIALS:

From a French multicentre cohort, we studied 1573 kidney recipients who were alive with stable graft function at 1 year post-transplantation, with no acute rejection in their first year post-transplantation.

RESULTS:

Using propensity score-based analyses, we did not observe any significant difference in the relative risk for graft failure between patients from centres with a 1-year SB policy and those from other centres [hazard ratio = 1.15, 95% confidence interval (CI) 0.86-1.53]. The corresponding adjusted survival probability at 8 years post-transplantation was 69% (95% CI 61-74%) for patients from centres with a 1-year SB policy versus 74% (95% CI 67-79%) for those from other centres.

CONCLUSION:

A 1-year SB policy for stable patients may not lead to therapeutical benefits for improved graft and patient survival. Further studies examining the benefits versus the risks of a 1-year SB policy are warranted to demonstrate the long-term utility of this intervention.

KEYWORDS:

causal inference; clinical utility; graft failure; kidney transplantation; screening biopsy

PMID:
30060106
DOI:
10.1093/ndt/gfy221

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