Complications of Ultrasound-Guided Renal Transplant Biopsies

Abstract

Renal transplant biopsies to diagnose transplant pathology are routinely performed using ultrasound guidance. Few large studies have assessed the rate and risk factors of major biopsy complications. This study is a single-center 5-year retrospective cohort analysis of 2514 biopsies. Major complications occurred in 47 of 2514 patients (1.9%) and included hospitalization, transfusion of blood products, operative exploration and interventional radiology procedures. The complication rate among "cause" biopsies was significantly higher than in "protocol" biopsies (2.7% vs. 0.33%, p < 0.001). Complications presented on postbiopsy days 0-14, with the majority diagnosed on the same day as the biopsy and manifested by hematocrit drop, although the presence of such delayed presentation of complications occurring >24 h after the biopsy on days 2-14 is previously unreported. Specific patient characteristics associated with increased risk of a complication were increased age and blood urea nitrogen, decreased platelet count, history of prior renal transplant, deceased donor transplant type and use of anticoagulant medications but not aspirin.

Effects of Aspirin Therapy on Ultrasound–Guided Renal Allograft Biopsy Bleeding Complications

“…Furness et al (3) reported a 0.40% major complication rate in a review of 2,127 renal allograft biopsies. Morgan et al (6) found a 1.9% major complication rate after 2,514 renal allograft biopsies, and Wilczek (4) reported a 2.8% major complication rate after 1,129 renal allograft biopsies. This disparity in outcomes likely stems from differences in how major complications were defined in each study (ie, complication classification system used) and differences in the biopsy technique.…”

“…Percutaneous renal allograft biopsies are considered to be safe procedures. Bleeding is the most common complication, with reported major bleeding complication rates of 0%–3% (3–6). …”

Tangential Extraperitoneal Retrorenal approach: a specified uniform technique for renal transplant biopsy

“…Still, their study reported cases of transfusion-requiring bleedings, intraperitoneal hemorrhage and rectus sheath hematoma. When the same technique was subsequently used in a larger single-center study capturing 2514 biopsies, it was associated with 1.9% major complications requiring hospitalization or therapeutic intervention [2]. Therefore, it was not much safer than the traditional biopsy approach.…”

“…By use of Doppler ultrasound, 12 AVF were detected (4.6%) neither of which required embolization. Our complication rates can be compared to historical data in Table 1 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Sample adequacy could be retrospectively assessed for 156 tissue core samples.…”

Innovative Perspective: Gadolinium-Free Magnetic Resonance Imaging in Long-Term Follow-Up after Kidney Transplantation

“…Although pathology findings currently are leading for therapy initiation or alteration, benefits of protocol biopsies for the early detection of subclinical allograft damage are seriously questioned due to considerable burden (Tanabe, 2014). Especially in the absence of any clinical signs indicating allograft dysfunction, kidney biopsy comes with risks and drawbacks, including a logistic burden for nephrology departments, discomfort in patients, risk of allograft bleeding, and, albeit to a lesser extent, infectious complications (Corapi et al, 2012; Chung et al, 2014; Morgan et al, 2016). Finally, there is a risk of sampling error which may confound adequate assessment of biopsy samples, (Madaio, 1990) since allograft fibrosis develops from focal lesions (Cosio et al, 2008).…”