Pre-discharge, post-transplant kidney biopsy does not predict rejection

The value of allograft biopsy 2 to 3 weeks after renal transplantation as a predictor of rejection was studied. Fifty non-HLA identical recipients had pre-discharge biopsy without complication. Biopsies were studied under light microscopy and with immunofluorescent stains; interpretation was done without knowledge of the clinical course and the biopsy was not used in patient management. Based on light microscopic findings, the patients were divided into three groups: normal (n = 33); acute interstitial infiltrate (n = 12), and acute tubular necrosis (n = 5). Subsequent course was determined. There was no difference between groups in percent patients having a subsequent acute rejection episode, timing of the first rejection, percent having more than one rejection, and percent kidneys currently functioning. Immunofluorescent studies did not help in predicting subsequent rejection. We conclude that pre-discharge biopsy does not predict subsequent course.