Added Benefit and Risk of an Additional Biopsy or Targeting With Contrast‐Enhanced Ultrasound for Patients With Renal Transplants

Abstract

Objectives-To determine whether renal transplant diagnoses substantially change when 2 biopsy sites are chosen and whether contrast-enhanced ultrasound (CEUS) has value for targeting the second site.Methods-We prospectively enrolled 40 patients undergoing ultrasound-guided renal transplant biopsy within 2 years of transplant: 20, surveillance; and 20, for cause. A CEUS examination was performed to identify cortical regions with subjectively altered flow. One biopsy was performed at the operator-preferred (primary) site regardless of CEUS findings. Another biopsy was done at a second location, either targeted to an area in which CEUS perfusion findings differed from the primary site (targeted) or at a random location (secondary) if no other area differed. Specimens were randomly labeled A or B; pathologists were blinded to the CEUS result and biopsy location. Location-specific CEUS assessments were recorded. Pathologic results were compared, including acute and chronic Banff scores and any new findings from the targeted or secondary biopsy.Results-Forty patients were enrolled between January 2016 and December 2018. No location-specific pathologic differences correlated with differences in CEUS assessments. The second biopsy provided additional information that changed management in 4 of 40 patients (10.0% [95% confidence interval, 2.8%-23.7%]). Major bleeding complications occurred in 3 of 40 (7.5%) patients.Conclusions-Contrast-enhanced ultrasound targeting was not useful. Major bleeding complications were higher than expected, possibly due to the additional biopsy away from the operator-preferred location. Obtaining a second renal transplant biopsy from a substantially different area than the initial operatorpreferred location provided additional clinically useful information in 10% of patients.

Complications of Percutaneous Kidney Allograft Biopsy: Systematic Review and Meta-analysis

“…After the removal of duplicates, 5004 unique records were identified, of which 4814 records were excluded after the screening of titles and abstracts. Of the 190 remaining studies, 72 studies (40 082 biopsies) 2,3,9,14,25-92 were included in the systematic review and meta-analysis after full-text review (Figure 1) including 4 single-center randomized controlled trials, 3 multicenter cohort studies (1 mixed retrospective-prospective and 2 retrospective), and 65 single-center cohort studies (10 prospective, 1 mixed retrospective-prospective, 46 retrospective, and 8 unreported). Details of the included studies are presented in Table S1, SDC, http://links.lww.com/TP/C332.…”