3:36 PM Abstract No. 203 Safety and efficacy of percutaneous computed tomography–guided transplant pancreas biopsy

Abstract

Percutaneous computed tomographic (CT)-guided biopsy is a minimally invasive alternative to open biopsy, not frequently described in the literature. The purpose is to describe and assess technique, complications, and diagnostic yield of CT-guided percutaneous transplant pancreas biopsy. This is a single institution retrospective review of 75 patients (47 women, 28 men, mean age 47) who underwent CT-guided transplant pancreas biopsy (n = 149) between April 2005 and October 2018.Three cases (2%) were aborted due to inadequate safe percutaneous approach. Biopsy results were classified based on final pathology as diagnostic (with the subcategory partially diagnostic used if the sample was adequate for the diagnosis of cell mediated rejection, but not humoral rejection) and nondiagnostic. Diagnostic yield and complication rates were evaluated. 149 percutaneous CT-guided biopsies of transplant pancreas were performed. 98% (n =143) of the biopsies used 17/18 Gauge coaxial core biopsy system, and 2% (n = 3) used a 19/20 Gauge coaxial device. On-site pathologic touch prep assessment was utilized for 91% of biopsies. Diagnostic tissue was obtained 94% of the time, of which 9% were considered partially diagnostic. 6% of the samples were deemed non-diagnostic. Of the diagnostic biopsies, 7 (51%) were positive for rejection (24% grade I, 16% grade II, 4% grade III, and 7% chronic) and 49% were negative for rejection. On-site pathologic touch prep did not appear to have an effect on sample adequacy (P = 0.9) nor did the number of cores (P =.28) or graft location (P = 1.0). The most common complication was minor bleeding (9%), pancreatitis (1%) and sedation related adverse events (1%); there was 1 moderate complication (hemorrhage requiring overnight observation), and no major complications. No significant difference in the INR (P = 0.68) or platelet count (P = 0.07) between patients who had bleeding complications and those who did not have bleeding complications. Image-guided percutaneous CT-guided transplant pancreas biopsies have high diagnostic yield with low complication rates.