Significance and safety of renal allograft biopsies: Experience from a tertiary care center in India

Abstract

Introduction: Renal allograft biopsy is a useful tool in the presence of allograft dysfunction. There are many published studies regarding utility and safety of native kidney biopsies, whereas for allograft biopsies, data are scarce. Methodology: This retrospective analysis included all patients who underwent renal allograft biopsies from January 1, 2012, to December 31, 2017. Data were collected from patient records and interviews. Details regarding clinical indications, preprocedure rise in creatinine, urine analysis, periprocedure fall in hemoglobin, postprocedure hematoma in ultrasonography, and other complications were noted. Details of biopsy findings were analyzed. We noted the changes made in treatment after renal biopsies. Results: One hundred and seventeen (n = 117) patients underwent 150 renal biopsy procedures, with a mean age of 38.3 ± 11.6 years. Ninety-two (78.6%) were male. The majority (89.74%) of the patients received kidney from live donors. The most common indication for biopsy was acute allograft dysfunction (54%) with asymptomatic rise in creatinine (32.7%). In the first 15 days posttransplantation, the most common indication was delayed graft function (15.33%). Ninety percent of biopsies were adequate. For clinical diagnosis of acute allograft dysfunction, the most common pathological finding was active antibody-mediated rejection (AMR) in 14.49% patients. In the presence of chronic allograft dysfunction, the most common histopathological finding was chronic AMR in 18 (13.04%) biopsies. Major complications occurred in 4.0% of patients. Conclusion: Renal allograft biopsy is a useful tool in the evaluation of allograft dysfunction, and with current biopsy technique under real-time sonography, the major complication rate is less. It can be regarded as a safe procedure with excellent diagnostic yield.