{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T12:19:04Z","timestamp":1790425144815,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","license":[{"start":{"date-parts":[[2019,5,2]],"date-time":"2019-05-02T00:00:00Z","timestamp":1556755200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Transplantation"],"published-print":{"date-parts":[[2019,5,2]]},"abstract":"<jats:p><jats:italic>Background<\/jats:italic>. The role of protocol renal allograft biopsy in kidney transplantation is controversial due to the concern with procedural-related complications; however, its role is slowly evolving. Recent evidence suggests that protocol biopsy is useful in detecting subclinical renal pathology. Early recognition and treatment of renal pathologies can improve long-term outcomes of renal allografts.<jats:italic>Methodology<\/jats:italic>. A total of 362 renal allograft protocol biopsies were performed in adult recipients of kidney transplantation between 2012 and 2017. After excluding those with poor quality or those performed with a baseline serum creatinine level &gt;200\u2009umol\/L, we analyzed 334 (92.3%) biopsies. Histology reports were reviewed and categorized into histoimmunological and nonimmunological changes. The immunological changes were subcategorized into the following: (1) no acute rejection (NR), (2) borderline changes (BC), and (3) subclinical rejection (SCR). Nonimmunological changes were subcategorized into the following: (1) chronicity including interstitial fibrosis\/tubular atrophy (IFTA), chronic T-cell-mediated rejection (TCMR), unspecified chronic lesions, and arterionephrosclerosis, (2) de novo glomerulopathy\/recurrence of primary disease (RP), and (3) other clinically unsuspected lesions (acute pyelonephritis, calcineurin inhibitors toxicity, postinfective glomerulonephritis, and BK virus nephropathy). Risk factors associated with SCR were assessed.<jats:italic>Results<\/jats:italic>. For the histoimmunological changes, 161 (48.2%) showed NR, 145 (43.4%) were BC, and 28 (8.4%) were SCR. These clinical events were more pronounced for the first 5 years; our data showed BC accounted for 59 (36.4%), 64 (54.2%), and 22 (40.7%) biopsies within &lt;1 year, 1-5 years, and &gt; 5 years, respectively (p = 0.011). Meanwhile, the incidence for SCR was 6 (3.7%) biopsies in &lt;1 year, 18 (15.3%) in 1-5 years, and 4 (7.4%) in &gt;5 years after transplantation (p=0.003). For the nonimmunological changes, chronicity, de novo glomerulopathy\/RP, and other clinically unsuspected lesions were seen in 40 (12%), 10 (3%), and 12 (3.6%) biopsies, respectively. Living-related donor recipients were associated with decreased SCR (p=0.007).<jats:italic>Conclusions<\/jats:italic>. Despite having a stable renal function, our transplant recipients had a significant number of subclinical rejection on renal allograft biopsies.<\/jats:p>","DOI":"10.1155\/2019\/9153875","type":"journal-article","created":{"date-parts":[[2019,5,2]],"date-time":"2019-05-02T23:38:15Z","timestamp":1556840295000},"page":"1-8","source":"Crossref","is-referenced-by-count":6,"title":["Clinical Significance of Renal Allograft Protocol Biopsies: A Single Tertiary Center Experience in Malaysia"],"prefix":"10.1155","volume":"2019","author":[{"given":"Mei Sian","family":"Fu","sequence":"first","affiliation":[{"name":"Department of Medicine, Hospital Segamat, 85000 Segamat, Johor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo Jin","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9198-8306","authenticated-orcid":true,"given":"Maisarah","family":"Jalalonmuhali","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kee Seong","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo Kun","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kok Peng","family":"Ng","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of 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