Early surveillance biopsy utilization and management of pediatric renal allograft acute T cell–mediated rejection in Canadian centers: Observations from the PROBE multicenter cohort study

Background Early TCMR surveillance with protocol kidney biopsy is used differentially among pediatric kidney transplant centers. Little has been reported about actual center‐based differences, and this variability may influence TCMR ascertainment, treatment, and monitoring more broadly. Methods Data from the PROBE multicenter study were used to identify patients from centers conducting ESB or LSIB. ESB was defined as >50% of patients having at least 1 surveillance biopsy in the first 9 months. Patients were compared for number of biopsies, rejection episodes, treatment, and follow‐up monitoring. Results A total of 261 biopsies were performed on 97 patients over 1‐2 years of follow‐up. A total of 228 (87%) of biopsies were performed in ESB centers. Compared to LSIB centers, ESB centers had 7‐fold more episodes of TCMR diagnosed on any biopsy [0.8 ± 1.2 vs 0.1 ± 0.4; P i1t1 and