The decision to treat patients with acute renal allograft dysfunction who are found to have borderline changes on their diagnostic renal allograft biopsies varies among clinicians. Few studies have specifically examined the influence of age and ethnicity on the treatment strategy utilized and the subsequent outcome among patients presenting with such biopsies. We retrospectively reviewed the records of 43 kidney transplant recipients with borderline allograft biopsies as defined by Banff criteria. Data were extracted from clinical and pathological records. The mean age at the time of transplantation was 42.6 ± 13.4 years. 72% were African American (AA), 41% were females, and 23% were 55 years or older. There was no significant difference in the mean serum creatinine at the time of biopsy between the AAs and Caucasians (C), (3.2 ± 1.8 mg/dL and 3.7 ± 3.0 mg/dL, respectively [p = .58]). Patients either received no treatment, high-dose steroids, or a change in immunosuppresion regimen. Neither the patients' age nor ethnicity appeared to influence the treatment strategy employed. At one year after biopsy the serum creatinine was similar in the AA and C patients (2.4 ± 0.7 mg/dL and 3.1 ± 2.6 mg/dL respectively). However, three years after the index biopsy 12 of the patients had returned to dialysis, 11 of which were AAs. Although the small sample size precludes definitive conclusions from this study, our data suggest that neither age nor ethnicity influenced the selection of the type of treatment strategy utilized in patients with borderline renal allograft biopsies. Furthermore, the higher rate of subsequent renal allograft failure among AAs during this study suggests that borderline changes in AAs may represent a more serious finding. Further studies are needed to address this subject.
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