Abstract
Introduction: Ultrasound-guided percutaneous kidney allograft biopsy is the gold-standard for pathology work-up. Recent studies postulate better safety and efficacy for tangential approaches, however, there is no recommendation regarding biopsy needle path. In this context, we previously described the unified tangential extraperitoneal retrorenal (TER) approach for standard allograft biopsy. Methods: A single-center retrospective observational study evaluated safety and efficacy of the TER biopsy approach among 250 patients that underwent 330 ultrasound-guided kidney transplant biopsies between January 2011 and May 2020. Results: The overall major complication rate was 0.56% per biopsy attempt (1.21% per biopsy) including blood transfusion, arterial embolization and bladder catheterization for gross hematuria in 0.28, 0.14 and 0.14% of biopsy attempts, respectively (0.61, 0.30 and 0.30% of biopsies, respectively). Minor complications included subcapsular and/or perinephric hematoma, superficial bleeding, arteriovenous fistula and gross hematuria in 12.6, 3.0, 2.5 and 1.4% of biopsy attempts, respectively (27.0, 6.4, 5.5 and 3.0% of biopsies, respectively). Sample adequacy rate was 86.7%, ranging from 82.2 to 94.1% if one or ≥two cores were analyzed, respectively. Residents and consultants yielded similar complication and adequacy rates. Conclusion: According to current literature, ultrasound-guided TER kidney transplant biopsy is a safe and efficient approach eligible for nephrology training.
Highlights
Ultrasound-guided percutaneous kidney allograft biopsy is the goldstandard for pathology work-up
We recently developed the so called tangential, extraperitoneal, retrorenal (TER) approach for standard allograft biopsy, that penetrates the allograft parallel to the renal capsule, keeps safe distance to the peritoneal fold, and targets the posterior side of the allograft in a lateral-to-medial approach
330 ultrasound-guided kidney transplant biopsies were performed among 250 patients between January 2011 and May 2020. 203 (61.5%) and 127 (38.5%) biopsies were performed on male and female patients, respectively. 194 (77.6%) patients underwent one biopsy, patients were subjected to kidney transplant biopsy up to five times. 2, 3, 4 and 5 biopsies were performed in 39 (15.6%), 11 (4.4%), 5 (2.0%) and 1 (0.4%) patient, respectively
Summary
Ultrasound-guided percutaneous kidney allograft biopsy is the goldstandard for pathology work-up. A tangential biopsy allows to direct the needle tip away from the renal hilum, the ureter, and large vessels of the anastomosis region, thereby sparing these anatomical structures from potential injury. In this regard, we recently developed the so called tangential, extraperitoneal, retrorenal (TER) approach for standard allograft biopsy, that penetrates the allograft parallel to the renal capsule (tangential component, T), keeps safe distance to the peritoneal fold (extraperitoneal component, E), and targets the posterior side of the allograft (retrorenal component, R) in a lateral-to-medial approach. In our present study we verify these results in a larger patient cohort by demonstrating excellent complication and adequacy rates among 250 patients undergoing 330 kidney transplant biopsies utilizing a conventional (96.1%) or modified (3.9%) TER approach. This is the first study to 1) assess both major and minor complications based on a standardized postprocedural ultrasound follow-up as well as to 2) confirm the eligibility of TER kidney transplant biopsy for nephrology training
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