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

Abstract

Background. Kidney biopsy is important to guide the management of allograft dysfunction but has a risk of complications. This review aimed to determine the incidence and risk factors of complications after kidney allograft biopsy. Methods. This is a systematic review and meta-analysis of randomized controlled trials, cohort studies, or case-control studies indexed on PubMed, Embase, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry, and ClinicalTrials.gov, limited to the English language, from January 2000 to December 2020, including adult and pediatric kidney allograft biopsies. Primary outcomes were gross hematuria, bleeding requiring transfusion, and major complications (requiring interventions such as blood transfusion or surgical or radiological interventions). Results. The review included 72 studies (40 082 biopsies). The quality of included studies was suboptimal. Pooled rates of gross hematuria, bleeding requiring transfusion, and major complications were 3.18% [95% confidence interval (95% CI), 2.31-4.19], 0.31% (95% CI, 0.15-0.52) and 0.89% (95% CI, 0.61-1.22), respectively. Gross hematuria rates were lower in high-income compared with middle-income countries (2.59% versus 6.44%, P < 0.01) and biopsies performed by radiology as compared with nephrology departments (1.25% versus 3.71%, P < 0.01). Blood transfusion rates were lower in pediatrics than adults (0.0% versus 0.65%, P < 0.01). Major complications were lower in biopsies performed by specialists as compared with trainees (0.02% versus 3.64%, P < 0.01). Graft loss and mortality were extremely rare. Limitations included missing data, few randomized controlled trials, and possible publication bias. Conclusions. The risk of complications after kidney allograft biopsy was low. Given the low quality of included studies, risk factors for complications should be further examined in future studies.

Significance of Arterial Spin Labeling for Reducing Biopsies in Patients With Kidney Allograft Dysfunction

“…A recent meta-analysis analyzing 40,082 biopsies from 72 studies showed that the incidence of postbiopsy bleeding requiring transfusion and major complications were 0.31% and 0.89%, respectively. 21 Consequently, there are relentless interests in the radiology and transplant community to search for alternative imaging biomarkers for guiding clinical management.…”

“…This study result showed that serum creatinine could be used to aid in the differentiation of the UNNECESSARY group from the NECESSARY group with moderate AUC, high sensitivity but unacceptably low specificity, indicating that many patients who may not need allograft biopsy may eventually receive this invasive procedure if serum creatinine was used as the sole determinant for biopsy. A recent meta‐analysis analyzing 40,082 biopsies from 72 studies showed that the incidence of post‐biopsy bleeding requiring transfusion and major complications were 0.31% and 0.89%, respectively 21 . Consequently, there are relentless interests in the radiology and transplant community to search for alternative imaging biomarkers for guiding clinical management.…”

Renal MRI: From Nephron to NMR Signal

“…Biopsy, particularly in allograft injury, is thus prone to profound sampling error and high inter/intra‐observer variability 45,46 . In terms of biopsy risks and complications, recent meta‐analyses show that while risk of major complications (0.3% of patients with bleeding requiring intervention in native and transplant biopsy), or death is infinitesimal (1 in 1667 patients with native and 5 in 38,593 with transplanted kidneys), there are non‐negligible risks (perinephric hematoma in 11% of native and 1.63% of transplanted kidneys, macroscopic hematuria in 3.5% of native and 3.2% of transplant biopsies) 47–49 …”

Successful Endovascular Treatment of Postbiopsy AVF in Transplanted Kidneys: Lessons Learned from Two Cases in Multiorgan Transplant Recipients

“…Small hemodynamically inconsequential AVF are often an incidental finding. 8 There are no clear guidelines for treatment of AVF. Some authors advocate "watchful waiting" for asymptomatic fistulas and intervention when renal function is threatened.…”