Gelatin-thrombin hemostatic matrix injection to salvage refractory post-renal graft biopsy bleed

Abstract

Post-renal biopsy bleeding refractory to angioembolization usually requires graft nephrectomy as a life-saving measure. Gelatin-thrombin hemostatic matrix injection in the needle tract is a novel attempt to control bleeding in such cases and to salvage the allograft. We hereby describe two cases of post-graft biopsy bleed. Both these patients continued to bleed even after angioembolization. They were shifted to the operating room upon developing hypotension, having received multiple blood transfusions with the intention of performing graft nephrectomy to save their lives. However, bleeding was successfully controlled by using Gelatin-thrombin hemostatic matrix injection in the biopsy needle tract. Patients improved hemodynamically after the procedure. Graft function returned to normal in both the cases. At an average follow-up of 10.4 months, both the patients have shown stable graft functions.

Ultrasound‐Guided Thrombin Injection for the Treatment of Bleeding Following Kidney and Liver Biopsies

“…Although intriguing, access to percutaneous microwave ablation equipment may be limited compared to alternative techniques. Direct intraoperative gelatin‐thrombin hemostatic matrix injection into patent renal biopsy tracks without ultrasound guidance was shown to be efficacious in two cases of hemorrhage refractory to angioembolization 29 . Thrombin is a particularly attractive agent for addressing vascular complications given its position in the clotting cascade.…”