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Master Thesis

Biopsies SystémAtiques de patients transplantés REnaux de novo à 3 mois post-chirurgie : impact sur la survie du greffon à 5 ans (SABRE)

Abstract : Background: In many kidney-transplant centers, a systematic kidney biopsy (SKB) is performed at 3 months after renal transplantation (M3), without a demonstrated benefit on death-censored graft survival (DCGRS). This DCGS depends on many variables with potential biases, especially in frail recipients. In this study, we compare DCGS between recipients receiving a SKB and those without, accounting for potential biases. Methods: This retrospective, single-center study was conducted between January 2007 and December 2013. We recruited all de novo kidney-transplant recipients with a minimum of 3 months survival. Recipients had or did not have a SKB performed (systematic M3 kidney biopsies were introduced in 2009). We built a propensity score (PS) for recipients and donors to evaluate the odds of having a biopsy. The primary endpoint was 5-year DCGS with or without SKB, while considering the PS (0.75 thresholds). Results: 660 patients were included: 333 had a M3 SKB, 286 did not (175 before 2009). In bivariate Kaplan--Meier survival analysis, a M3 SKB was associated with better 5-year DCGS independently of the PS (p<0.001). Three groups were distinguished: patients with a SKB and a PS >0.75 had the best DCGS, patients without a SKB and a PS of <0.75 had the worst DCGS, and the other patients had an intermediate DCGS. Conclusions: A M3 SKB was associated with improved graft survival independently of a recipient’s comorbidities, as evaluated by PS. These results could be explained by the identification and early treatment of subclinical immunological events. It could also be due to better management of the immunosuppressive regimen, especially appropriate steroid withdrawal.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02535530
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Submitted on : Tuesday, April 7, 2020 - 4:18:19 PM
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Florian Terrec. Biopsies SystémAtiques de patients transplantés REnaux de novo à 3 mois post-chirurgie : impact sur la survie du greffon à 5 ans (SABRE). Médecine humaine et pathologie. 2019. ⟨dumas-02535530⟩

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