Kidney allograft surveillance biopsy practices across US transplant centers: A UNOS survey

Background The approach to the diagnosis and management of subclinical rejection (SCR) in kidney transplant recipients remains controversial. Methods We conducted a survey through UNOS across US transplant centers regarding their approach to surveillance biopsies and reasons for the nonperformance of surveillance biopsies. Results Responses were obtained from 106/238 centers (45%), and only 18 (17%) of the centers performed surveillance biopsies on all patients and 22 (21%) performed biopsy for select cases. The most common time points for surveillance biopsies were 3 and 12 months post-transplant. The common reasons for not performing biopsies were low yield (n = 44, 65%) and the belief that it will not change outcome (n = 24, 36%). The incidence of SC-TCMR was ≥ 10% among 39% of centers. The mean serum creatinine was slightly worse by 0.06 mg/dL at 1 year and 0.07 mg/dL at 3 years among centers performing biopsy, P