Histologic findings in protocol biopsies performed in stable renal allografts under different immunosuppressive schedules

Protocol biopsies performed in stable renal allografts show different degrees of acute and chronic lesions. Histologic findings in protocol biopsies have been related to graft outcome. We evaluated histologic lesions observed in protocol biopsies performed in patients under different immunosuppression therapies. From June 1988 a protocol biopsy was performed at approximately 4 months in patients who fulfilled the following criteria: serum creatinine <300 mumol/L; stable renal function; and proteinuria <1 g/d. Histologic lesions were graded according to 1997 Banff criteria. For the present study we considered the following groups according to immunosuppressive schedule: (i) induction therapy with polyclonal. or monoclonal antilymphocytic antibodies associated with cyclosporine and prednisone (n = 201); (ii) cyclosporine, mycophenolate mofetil, and prednisone (n = 127); and (iii) tacrolimus, mycophenolate mofetil, and prednisone (n = 51). On protocol biopsy patients treated with tacrolimus displayed a lower acute score (0.61 +/- 1.01 vs 1.24 +/- 1.23 in group I, 1.28 +/- 1.41 in group II; P <.0001) and a higher proportion of normal biopsies (57.1% vs 41.9% in group I, 45.1% in group II; P = .016). A similar proportion of chronic lesions (chronic score of group I: 1.30 +/- 1.56; group II: 1.34 +/- 1.80; group III: 1.51 +/- 0.95; P = NS) was observed in the three groups. Protocol biopsies displayed fewer acute lesions in patients treated with tacrolimus. This result suggests that the efficacy of new immunosuppression schedules can be evaluated using the protocol biopsy as a surrogate marker of graft outcome.