Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background: Early graft monitoring has the potential to extend the renal graft survival in pediatric recipients. By the time that clinical diagnosis is confirmed histologically, renal scarring may be too advanced to make delayed treatment a realistic option. Surveillance biopsy has been useful in detection of subclinical immunological as well as non- immunological graft injury.The aim of the study is to study the pathological graft data one month post transplantation by surveillance biopsy and to evaluate the histopathological impact of different immunosuppression protocols on the graft four months post transplantation. Methods: This is a prospective interventional cohort study that included 20 living donor renal transplant recipients being followed up at kidney transplantation outpatient clinic, Cairo university children`s Hospital (Abo Elreesh).All cases received the classic triple maintenance immunosuppression protocol (CNI, steroids and MMF) for one month then cases were subdivided into two groups based on their maintenance immunosuppression therapy furthermore: group (A) (12 cases) continued on CNI based triple therapy protocol, group (B) (8 cases) shifted to m-TOR inhibitors low dose CNI protocol. Surveillance biopsies were done for all cases at one and four month post-transplantation. Results: One month surveillance biopsies were totally normal in 9 (45%) cases. Acute CNI toxicity was found in 5 (25%) cases. Subclinical rejection (SCR) was found in 4 (20%) cases (Acute SCR in 2 cases and borderline subclinical changes in 2 cases). Four month surveillance biopsy revealed 6 (30%) cases with SCR 5 cases with acute SCR of the evirolimus based immunosuppression and 1 case with borderline subclinical changes of the classic triple therapy

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