Course and Relevance of Arteriovenous Fistulas After Renal Transplant Biopsies

Abstract

Arteriovenous fistulas (AVFs) after renal transplant biopsy are considered harmless. However, verification of the clinical course has not been thoroughly documented. We evaluated the data of our outpatient renal transplant biopsy program regarding the clinical course of AVFs after 2824 biopsies since 2000. We also reviewed all selective renal transplant embolizations. AVFs were the most frequent biopsy complications (8.3%). Seventy-seven percent of AVFs disappeared spontaneously. Renal function in patients with AVFs was not different compared to those without during 2 years of observation. There were no differences in AVFs comparing protocol or indication biopsies, needle size, the time after transplantation, the use of acetylic salicylic acid or serum-creatinine at biopsy. Living or younger donors were less likely to get postbiopsy AVFs. Ten embolizations were performed. Only one patient was from our outpatient biopsy program. Nine others were biopsied as inpatients in the course of complications during 6 weeks after transplant. Six of nine successfully embolized patients profited with improvement of renal function. Large AVFs occur most commonly shortly after transplantation in patients with poor graft function. There is no established test predicting which patient will benefit from embolization; however, Doppler-determined resistive index may help in this regard.

Potential of Noninvasive Serial Assessment of Acute Renal Allograft Rejection by 18F-FDG PET to Monitor Treatment Efficiency

“…Therefore, some authors suggest performing protocol biopsies at a defined time course after transplantation, irrespective of the status of graft function (8). As an invasive procedure, biopsy carries the risk of significant graft injury and is not feasible in patients taking anticoagulant medication (10,11). Moreover, the limited sampling sites (randomly chosen, and exceedingly small, portions of tissue) may lead to falsenegative results, such as when rejection is focal or patchy.…”

Vascular Complications in Kidney Transplantation

“…Rarely, renal graft ischemia may be the result of steal phenomenon from a large AVF (Harrison, 1994, Matsell, 1992. Factors that may predispose to the development of arteriovenous fistula include early postransplant period, the presence of hypertension, sclerosis and interstitial fibrosis, the formation of intrarenal hematoma (Schwarz, 2008). About 70% of AVF cases resolve spontaneously within weeks or months (Matsell, 1992).…”

“…In the majority of cases, successful embolization can be achieved using coils or microcoils. Schwarz et al (Schwarz,2008) proposed a hemodynamic prognostic test to predict which AVF would probably profit from AVF coiling, by comparing Doppler sonographic resistive indices of the main renal artery and the non-AVF associated segmental arteries (Schwarz, 2008). The resistive index of the main renal artery should be at least 0.05 less than that of the non-AVF-associated segmental renal arteries indicating under-perfusion of the rest renal parenchyma.…”

Comments and extensions to EFSUMB guidelines on renal interventional ultrasound (INVUS).

“…Interventional embolization and coiling of the feeder vessel or the aneurysm itself are rarely required. Malignant conversion with total or partial organ loss, is rare [25,66,[70][71][72][73][74][75][76][77][78][79][80][81].…”