Biopsy after transplant?

[okarol]

A staff member from hospital mentioned that Jenna would get a biopsy at 6 months and one each year after transplant. I said, "no, I never heard that before...? Aren't biopsy's risky, and only done when rejection is suspected?" The girl was calling because she wanted permission to retain a "small piece" from each biopsy for a research project. She said that we should have been told that the biopsy was standard protocol for the center, and keeping a piece for the research project was optional. I said, "I don't recall ever hearing about the plans to do periodic biopsies, and could someone from the team call us back?" Jenna also does not recall any discussion of biopsies. Anyone have any insight here?

[kitkatz]

I know nothing about the actual answer to this question, but in my opinion the less messing with the kidney the better

[angela515]

I neve had a biopsy after my transplant until 4 yrs later when I was in rejection. I dont think I would allow a biospy to be done unless in rejection. 

[BigSky]

There are risks for all medical procedures.  Nothing is risk free.

It all depends on the transplant center as to biopsys. 

Some do it to see just what is happening with the kidney. 

Even though the kidney may not be rejecting it can be damaged by the medication to suppress the immune system.  They maybe trying to judge the health of the kidney through the years and see if any such damage is occurring to it from medication or the immune system.

[Zach]

A staff member from hospital mentioned that Jenna would get a biopsy at 6 months and one each year after transplant. I said, "no, I never heard that before...?

My center has the same requirement.  Not that they tell the patients during the years they're waiting for the transplant.

[angieskidney]

I only had one biopsy after my transplant and that was just because they suspected rejection which they were able to stop (rejection is common right after a transplant and they watch for that and stop it with more immunosuppressant meds).

I would ask if that is protocal and if it is manditory. I don't see why they would do that but I guess they feel it is better safe than sorry. There are other signs of rejection they can look out for besides having to do a biopsy.

[kelliOR]

My transplant center's protocol called for a 6 month and 1 year biopsy.  However, during the first 6 months I had a total of 4 biopsies.  Labs and ultra sounds may yield some information of the health of the transplanted kidney, but only a biopsy can indicate what is happening on a cellular level. I had had a slight rise in creatinine without any other symptoms.  I had showed some acute rejection after a month and was treated with medication.  A later biopsy showed some toxicity from my meds which needed adjustment  So far I'm doing well.  Its quite a ride the first 6 months.

There's a saying around transplant centers that "They give you a new kidney (heart, lung, liver) and take it back one piece at a time".

[angieskidney]

My transplant center's protocol called for a 6 month and 1 year biopsy.  However, during the first 6 months I had a total of 4 biopsies.  Labs and ultra sounds may yield some information of the health of the transplanted kidney, but only a biopsy can indicate what is happening on a cellular level. I had had a slight rise in creatinine without any other symptoms.  I had showed some acute rejection after a month and was treated with medication.  A later biopsy showed some toxicity from my meds which needed adjustment  So far I'm doing well.  Its quite a ride the first 6 months.

There's a saying around transplant centers that "They give you a new kidney (heart, lung, liver) and take it back one piece at a time".

lol nice! Ya in that case they would need to do a biopsy. I just never heard of doing on for no reason (6 months and 1 year no matter what)

[livecam]

They may have put her into some sort of a study group where results from these biopsies would become statistics.  Unless rejection or some other major problem is suspected there is no good reason for a biopsy to be done.  Standard blood tests and or less invasive procedures such as an ultrasound exam should be able to tell the whole story.  For now I would go with the program and make sure she gets transplanted.  After the transplant if labs are good tell them to forget the biopsies.  They won't be able to do a thing about it.  As a side note I was called back to the hospital a couple of weeks after my transplant because rejection was suspected.  They told me to prepare for a biopsy but that they wanted to do an ultrasound first.  The ultrasound was normal so the biopsy was cancelled.  My labs returned to normal almost immediately.  My problem was dehydration, I just wasn't drinking enough.  Several years of the renal diet and fluid restrictions take a while to get away from.

[Zach]

They won't be able to do a thing about it.

That's true.  What are they going to do?  Take out the kidney?     

[angela515]

My problem was dehydration, I just wasn't drinking enough. Several years of the renal diet and fluid restrictions take a while to get away from.

That's so true.... I remember after my transplant when they told me to drink and don't stop drinking... I remembered thinking, "Hey, no problem, I will drink till I go to sleep.", then I remember after drinking so much I was getting full and couldn't drink as much as they wanted me too... I had to slowly work my way up to the amount they wanted me to drink! 

[livecam]

Off subject but also you should find out what sort of immunosuppression they plan to use.  Will it be a steroid free protocol?  If not I highly suggest that you request one.  Most of the evils of Prednisone you may have heard about are true.  If you get away with none you'll be miles ahead in terms of limiting puffiness, bloating, and appetite side effects not to mention the mental well being of the patient.  In my opinion the most minimal immunosuppression that works is best because it offers the lowest amount of toxicity to the graft.  You want just enough to keep the kidney happy while minimizing damage. The gold standard these days seems to be a combination of Prograf and Cellcept.  Expect high levels of immunosuppression in the beginning that will be tapered off as time goes by.  

[angela515]

Off subject but also you should find out what sort of immunosuppression they plan to use.  Will it be a steroid free protocol?  If not I highly suggest that you request one.  

It also depends on other medical issues... not just the transplant. For example, I have SLE (Lupus), for over about 10 years I was on Prednisone to control my SLE and once I went into remission I was taken off of it. However, after my first transplant I was put back on it, obviously for transplant reasons, but the main reason was to keep my SLE in remission, b/c if it's not it will attack the transplant. So, if you can get away with no prednisone after transplant, yes, I also suggest it, however... in some cases it is not possible due to other medical reasons.

[Jill D.]

I had a biopsy of my new kidney less than 2 weeks after my transplant. I wasn't real happy about it, but I had a positive-crossmatch kidney transplant and this was the only way to see if the antibody level in my labs was of concern to my new kidney. As it turned out, everything was good, but this was the only way to see things at a cellular level. Mayo Clinic's protocol is to "possibly" have a biopsy of the new kidney at the 4-month follow-up, and also possibly at the 1 year check up. I think it also depends on the cause of your kidney failure. Mine was caused by FSGS, and there always is the possibility that the disease could recur in the new kidney, so if my labs start showing decreased function in my new kidney the only way to know if the FSGS is returning is with a biopsy.
I, frankly, prefer that they leave my "new friend" alone!

[angieskidney]

My problem was dehydration, I just wasn't drinking enough. Several years of the renal diet and fluid restrictions take a while to get away from.

That's so true.... I remember after my transplant when they told me to drink and don't stop drinking... I remembered thinking, "Hey, no problem, I will drink till I go to sleep.", then I remember after drinking so much I was getting full and couldn't drink as much as they wanted me too... I had to slowly work my way up to the amount they wanted me to drink! 

Yeah I remember when I had my transplant they kept waking me up and asking me to drink every hour and I was thinking, "Damn it just let me sleep! I will drink when I am awake like normal people do!!" lol

[okarol]

I spoke to the coordinator about the biopsy. She said it's become standard to take a "baseline"
biopsy at one month following transplantation. I wanted to know how to determine if the benefit
outweighs the risk of the procedure. I had researched everywhere on the internet and could not
find any similar protocol or info. She said she would find out. She also said, as with any medical
procedure, Jenna had the right to refuse it when it comes up, if she wants.

[Rerun]

Towards the 16th year of my kidney transplant they told me it was just wearing out.  Then they wanted to do a biopsy.  I said "we both know what is wrong, I don't need proof."

I've heard of two instances where they went to do the biopsy and "blew" the kidney.  I don't know what that means.  I assume they hit an artery.

Unless the labs are bad I would NOT allow a biopsy.

[angela515]

My center does not do a biopsy unless rejection is suspected.

[angieskidney]

Towards the 16th year of my kidney transplant they told me it was just wearing out.  Then they wanted to do a biopsy.  I said "we both know what is wrong, I don't need proof."

I guess they like to do a biopsy EVEN if they KNOW it is rejection that can't be stopped because they want to know what caused the rejection. They want to know if it was caused by not taking the medication. Then they would deny your ability to go back on the transplant list right away ..

But if they find it is natural causes / wearing out / etc then they put you on the list again right away.


Please correct me if I am wrong as I might be.