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- Title
Safety and Specimen Adequacy of Ambulant Renal Transplant Biopsies.
- Authors
Schwarz, A.; Gwinner, W.; Hiss, M.; Radermacher, J.; Eisenberger, U.; Mengel, M.; Haller, H.
- Abstract
Objective: In order to establish a protocol biopsy program after renal transplantation, we started to perform renal transplant biopsies on a day-care basis in October of 2000. Since then, we performed 1,470 ambulant biopsies on 796 patients. Methods: Biopsies were done using an 18-gauge automated biopsy needle (since October 2003 16 gauge) followed by 4 hours bed rest in hospital with blood pressure and urine control as well as an ultrasound before and after biopsy, keeping the patient in hospital in cases of complication or rejection. Results: 1,039 protocol biopsies were performed in 444 renal transplant patients (1st biopsy after 6 weeks, n = 356, 2nd biopsy after 12 weeks, n = 358, 3rd biopsy after 6 months, n = 325); as well as 431 biopsies on indication in 384 patients (creatinine increase or proteinuria). The following complications were observed: Gross hematuria n = 55 (3.7%); hospitalization 20, urinary catheter 12, blood transfusion 1; Perirenal hematoma (ultrasound) n = 31 (2%); hospitalization 7, blood transfusion 4; Vasovagal reaction n = 7 (0.5%); hospitalization 3; av-fistula (doppler sonography) n = 113 (7.7%); persistent 14, spontaneous resolution 46, without control 53. There was no statistically significant difference between complications in protocol biopsies and biopsies on indication (hematuria, 3.8 vs 3.5%; perirenal hematoma, 2.4 vs 1.4%; vasovagal reaction, 0.7 vs 0%; av-fistula, 7.8 vs 7.4%); and no significant difference using a 18 gauge (1,222 biopsies) or a 16 gauge needle (248 biopsies) (hematuria, 4 vs 4%; perirenal hematoma, 2 vs 3%; av-fistula, 8 vs 4%). According to the Banff criteria of specimen adequacy, all biopsies had sufficient cortical area for evaluation of interstitial fibrosis and tubular atrophy; however, evaluating one tissue core, 49.6% of biopsies showed <7 glomeruli and/or no arterial cross section (18 gauge needle). Specimen adequacy increased using a 16 gauge needle (only 19% <7 glomeruli and/or no arterial cross section). Conclusions: We conclude that outpatient renal transplant biopsies can be performed safely and allow for the establishment of a protocol biopsy program. To ameliorate specimen adequacy, we changed from 18 to 16 gauge biopsy needle. Relevant biopsy complications like gross hematuria or perirenal hematoma are usually noticed during the 4 hours of bed rest following the biopsy. Biopsyinduced av-fistula are frequent and are either resolved spontaneously or remain without clinical importance.
- Subjects
KIDNEY transplantation; CLINICAL pathology; BIOPSY; BLOOD transfusion reaction; HEMORRHAGE; BLOOD transfusion; URINALYSIS
- Publication
Kidney & Blood Pressure Research, 2004, Vol 27, Issue 5/6, p292
- ISSN
1420-4096
- Publication type
Article