Safety and Adequacy of Renal Transplant Protocol Biopsies

Abstract

The protocol biopsy strategy has been criticized because of risks and marginal utility. We tested the risk.We performed 1171 protocol biopsies in 508 patients at 6, 12 and 26 weeks after renal transplantation, as well as 499 biopsies as indicated in 429 transplant patients. Biopsies were done as an outpatient procedure using an 18-or 16-gauge automated biopsy needle followed by 4 h bed rest.Complications were: gross hematuria 3.5%, perirenal hematomas 2.5%, arterio-venous fistulas 7.3% and vasovagal reactions 0.5%. Major complications requiring invasive procedures such as blood transfusions or urinary catheter were seen in 1% of cases. The hospitalization rate for observation was 1.9%. According to the Banff criteria of specimen adequacy, biopsies with 18-gauge needles yielded >7 glomeruli and at least one artery in 53% of cases. Changing the needle size in October 2003, those biopsies done with 16-gauge needles yielded >7 glomeruli and at least one artery in 76% of cases, while the rate of major complications did not change.In conclusion, transplant protocol biopsies with 16-gauge needles provide better utility and similar risk as biopsies with 18-gauge needles. A 4-h recovery after biopsy appears adequate for discharge.

Tribbles-1 as a Novel Biomarker of Chronic Antibody-Mediated Rejection

“…Six-month protocol biopsies (Protocol Biopsy Program, Hannover, Germany 33,34 ) were classified according to the updated Banff classification criteria 3,35 as showing normal histology (n ϭ 6), lesions of IF/TA of unknown etiology (n ϭ 7), or CNI tox (n ϭ 7). The demographic and clinical data for these patients are provided in Table 2.…”

Protocol Transplant Biopsies

“…Two recent studies from Europe are reassuring, as they report a low major complication rate (including transfusion requirement and catheterization) of between 0.4 and 1%, with only one graft lost in approximately 2500 biopsies (1,2).…”

Safety and Efficacy of a Calcineurin Inhibitor Avoidance Regimen in Pediatric Renal Transplantation

“…The literature indicates that borderline changes may or may not resolve with increased immunosuppression, and their prognostic significance may vary according to the immunosuppressive protocol, pediatric versus adult recipient population under study, and other factors (47)(48)(49)(50)(51). Although mRNA and immunohistologic characteristics of these infiltrates will be reported separately, it is clear from this and other studies that protocol biopsies can be used safely to monitor renal transplant recipients (52,53). Moreover, such biopsies suggest that at least in some patients, an early and transient posttransplantation inflammatory or immune response is under way.…”