The Utility Of Protocol Biopsy In Renal Recipients Meta Analysis And Systematic Review

Objective:. To evaluate the value of protocol biopsy in patients after renal transplantation.Methods:Searches were applied to the following electronic database:Medline、 Embase Database, Cochrane Library. Randomized controlled trails evaluating the value of protocol biopsy for renal allograft recipients were included. Data were extracted independently by two reviewer. The risk of bias of included studies was assessed by the the Cochrane collaboration’s tool for assessing risk of bias. Statistical analysis were performed with Ravman5.0.Results:5RCTs were included. Long term graft loss was significantly reduced (RR0.40,95%CI0.25to0.65, P<0.001) by detection and treatment of subclinical pathological disorder after renal transplantation. Detection of subclinical pathological disorder by protocol biopsy and proper treatment may reduce the long term serum creatinine (WMD-38.21,95%CI-54.83to-21,60, p<0.00001). For renal recipients whose basal immunosuppression is CNI (tacrolimus or cyclosporine), detection and treatment of subclinical pathological disorder can significantly improve the long term eGFR (SMD0.78,95%CI0.51to1.05, P<0.00001). However, for those whose basal immunosuppression is tacrolimus, this effect is not notable. Detection of subclinical pathological disorder by protocol biopsy and proper treatment seem to have no significant beneficial effect of reducing clinical acute rejection episodes. The prevalence of subclinical rejection interstitial fibrosi/tubular atrophy、CNI toxicity、detected by protocol biopsy are3%-56%、0-58.6%and0-29%, respectively. The incidence of BK virus associated nephropathy after renal transplantation is2.0%-4.7%. The incidence of protocol biopsy related complication is1.1%-10%, no graft loss or death caused by protocol biopsy was reported.Conclusion:Treatment of subclinical pathological disorder detected by protocol biopsy can significantly improve the graft survival and may improve the allograft function. The incidence of main complication of protocol biopsy is rare.