Protocol biopsy: what is the rationale and what is the evidence?

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Abstract
The incidence of acute rejection (and the proportion of grafts lost during the first year after renal transplantation) have markedly decreased after the introduction of cyclosporin A. The reduction of the rate of graft loss after the first year, however, has been much less impressive. Chronic transplant nephropathy has become the most common cause of late graft failure [1]. Chronic allograft nephropathy is strongly correlated with the number of acute rejection episodes during the first year after renal transplantation [2,3]. In the past, the possibility of graft failure was suspected only when a sustained and irreversible decline of renal function was evident, usually in the context of proteinuria and hypertension. Unfortunately, by the time the clinical diagnosis was confirmed by histology renal scarring was usually too advanced to make delayed treatment a promising proposition.