Abstract: TH-PO827
Impact of Modified Delayed Graft Function (DGF) Biopsy Protocol on Patient and Allograft Outcomes: A Retrospective, Single-Center Study
Session Information
- Transplantation: Clinical - 2
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Umapathy, Swarna laxmi, Emory University, Atlanta, Georgia, United States
- Son, Jae H., Emory University, Atlanta, Georgia, United States
- Eccleston, Jayden, Emory University, Atlanta, Georgia, United States
- Vasudevan, Karthiga, Georgia Department of Public Health, Atlanta, Georgia, United States
- Rajendran, Abinaya, Pondicherry Institute of Medical Sciences, Pondicherry, Puducherry, India
- Demartino, Ryan, Emory Healthcare, Atlanta, Georgia, United States
- Vasanth, Payaswini, Emory University, Atlanta, Georgia, United States
Background
The traditional DGF biopsy protocol (defined as weekly biopsy until resolution of DGF) was modified by delaying the first biopsy until two weeks post-transplantation, with subsequent biopsies performed only if indicated. Our Study seeks to evaluate the impact of implementing a modified DGF biopsy protocol on patient and allograft outcomes.
Methods
We conducted a retrospective analysis of kidney transplant recipients with DGF 2021-2023, comparing outcomes between those managed under the traditional and modified protocols
Results
450 patients who had DGF in 2021-2023 were included in this Study. Results are outlined in Table 1. In 2021, under the traditional biopsy protocol, 19 patients (14%) experienced rejection, with the majority having borderline results, and some showing v1 lesions that were not treated due to DGF recovery. In 2022 and 2023, with the new biopsy protocols, 23 (14%) and 13 (8%) experienced rejection, with the majority having borderline results and only a few needing clinically significant treatment. Technical, vascular issues and recurrent disease resulted in graft failure and was unrelated to DGF.
Conclusion
Implementing the new protocol significantly reduced early DGF biopsies without negatively impacting patient and allograft outcomes. Moreover, this change led to significant cost savings, with each biopsy costing approximately $3000, alongside reductions in length of stay and readmission rates associated with biopsy procedures. These findings underscore the efficacy of protocol adjustment in enhancing both the clinical and economic aspects of post-transplant care.
| 2021 | 2022 | 2023 | |
| DGF rate | 137/383(35%) | 154/378(41%) | 159/365(44%) |
| Week 1 biopsy | 84/137(61%) | 18/154(12%) | 7/159(4%) |
| Rejection | 19/84(22%) | 6/18(33%) | 4/7(57%) |
| No rejection | 65/84(77%) | 12/18(67%) | 3/7(43%) |
| Week 2 biopsy | 54/154(35%) | 23/159(14%) | |
| Rejection | 17/54(31%) | 9/23(39%) | |
| No rejection | 37/54(69%) | 14/23(61%) | |
| Allograft function 1 year post transplant | |||
| creatinine <1 | 14(15%) | 17(11%) | 27(17%) |
| creatinine 1 - 2 | 97(70%) | 101(65%) | 96(60%) |
| creatinine 2 - 2.5 | 10(7%) | 13(8%) | 16(10%) |
| creatinine > 2.5 | 9(6%) | 16(10%) | 11(7%) |
| Failed (including non DGF causes) | 3(2%) | 7(4%) | 9(5%) |