Antibodies and Biopsy

[Wat76]

Good Morning Everyone, Please explain to me why I need a biopsy on my new kidney. My transplant team say my antibodies are high and they need to see why. I don't understand all this. So please help me to understand. My transplant was 26 Sep. Does this mean rejection? Is it preventative? I really don't understand. I pray my new kidney is not rejecting. I dont have any of the symptoms I have read. Help

[iolaire]

Biopsy's are fairly common in some transplant programs.  (Other programs do not do biopsy's, and some of our members are in no biopsy programs or fear them because they do have risks.)  Basically they want to get a piece of the kidney and look at it under a microscope to see if they see the effect of rejection on the cells of the kidney and if so they can adjust your treatment to prevent rejection.  If there is no sign of rejection then the know to look somewhere else for the cause of the high antibodies.

Its good you have no symptoms, they are following your labs closely and want to address rejection risk well it is still treatable.

My program does a biopsy fairly soon after transplant and then at a year out.  They sped up my annual biopsy because they saw inflammation in my blood and when the results came back they mostly ruled out rejection, but they were considering doing another one as a final check until they settled on another test to do instead.

The biopsy's for me were straightforward, you go in and wait around on a bed in a shared room, they wheel you down and likely wait a bit for the biopsy room, a nephrologist, the biopsy doctor, a biopsy tec and maybe another person are all crammed into the room.  You are awake during the biopsy and they explain everything.  They do topical numbing and then a needle to numb down deep and then the huge biopsy need goes down and clicks to grab a sample.  The nephrologist looks at the sample under a microscope to see if they captured a good sample and then its done.  The hardest part for me is once they pull out the needle they press down hard on the biopsy site to try to seal the wound, that holding the site was more painful for me than the biopsy.  Afterwards you go back up to the floor in the bed to wait 4 or more hours for them to see via blood tests if you have internal bleeding, if all is well you go home afterwards.

Here is the report on my first biopsy 3 months out:
http://ihatedialysis.com/forum/index.php?topic=34003.msg518487#msg518487

[KarenInWA]

Good Morning Everyone, Please explain to me why I need a biopsy on my new kidney. My transplant team say my antibodies are high and they need to see why. I don't understand all this. So please help me to understand. My transplant was 26 Sep. Does this mean rejection? Is it preventative? I really don't understand. I pray my new kidney is not rejecting. I dont have any of the symptoms I have read. Help

HI Wat76. Have you had your biopsy yet? If yes, how did it go?

I am of the belief that biopsies should only be done if there is a necessary reason to do so. High antibodies would be one of them. The more antibodies you have, the higher the risk is for rejection. I assume your team wants to do the biopsy so they can have more information to assess your risk going forward.

I am a member who had a very bad biopsy experience. My first transplant was in November 2011, from a living donor who is a non-blood-related family member. I had my biopsy in early April 2012, to rule out the slight risk of rejection due to my creatinine going from 1.4 to 1.7. I now know that is not a good enough reason (at least for me it isn't). That biopsy made a hematoma develop on my kdiney, which got so big it pressed against it and it stopped producing urine. The biopsy was on a Tues or Wednesday, and it didn't get that bad until that Saturday, when I woke up with no urge to pee. I ended up in the ER, had emergency surgery to save my kidney (my transplant surgeon was there that weekend, thankfully) and it took some time to recover. My creatinine got as bad as 9.9, and it took several months to settle in the low 3's. I was put back on the list in Summer 2013. I was lucky that my kidney was stubborn enough to keep me off dialysis until I received my 2nd one in November 2017 from a high-risk deceased donor. I will be celebrating 2 years on November 21st. No biopsies have been done on my 2nd kidney.

The dr who did that biopsy no longer practices at my transplant center. The 2 dr's I've had since then (the one who replaced her, and the one who was taking in the new tx patients when I got my 2nd one) have never uttered the word biopsy to me. Granted, I don't think any dr would have recommended doing another biopsy on the first one, and there has been no reason to on my 2nd one..

KarenInWA