Kidney allograft biopsy: timing to complications

Yablon, Z; P, Recupero; McKENNA, Jeffrey K.; Vella, John P.; Parker, Marti G.

doi:10.5414/cnp74039

Cited by 26 publications

(12 citation statements)

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“…Bleeding is often captured late into the postoperative period (up to 2 weeks) , but few studies have focused on bleeds occurring within 24–48 h after kidney transplantation . It is important to distinguish early and late postoperative bleeds because the latter are not commonly due to the surgery but are instead characterized by distinct risk factors including biopsy procedures or therapeutic systemic anticoagulation .…”

Section: Introductionmentioning

confidence: 99%

Postoperative surgical-site hemorrhage after kidney transplantation: incidence, risk factors, and outcomes

et al. 2017

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Studies investigating the incidence, risk factors, and outcomes of surgical-site hemorrhage after kidney transplantation are limited. Patients who underwent a kidney transplant from 1 January 2000 to 30 September 2012 (followed until 31 December 2012) at Toronto General Hospital were included in this study. Postoperative surgical-site hemorrhage was defined as a drop in hemoglobin ≥20 g/l over a 24-hour period within 3 days of transplantation, followed by an ultrasound indicating a significant hematoma/collection. A total of 59 of 1203 (4.9%) kidney transplant recipients had postoperative surgical-site hemorrhage. Most cases (89.8%) occurred within 1 day after transplantation. Living donor transplants [OR 0.30 (95% CI: 0.16, 0.55)] and higher recipient BMI [OR 0.54 per 10 kg/m increase in BMI (95% CI: 0.30, 0.99)] were associated with a significantly lower risk of bleeding. Chronic preoperative anticoagulant usage led to an increased risk of bleeding but was not statistically significant [OR 1.75 (95% CI: 0.52, 5.88)]. Postoperative hemorrhage was associated with a higher risk of graft loss or death [HR 1.62 (95% CI: 1.01, 2.60)]. While the incidence of postoperative surgical-site hemorrhage in kidney transplantation is relatively low, it may be associated with an increased risk of graft loss or death.

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Section: Introductionmentioning

confidence: 99%

Postoperative surgical-site hemorrhage after kidney transplantation: incidence, risk factors, and outcomes

et al. 2017

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“…Macroscopic hematuria after biopsy occurs in 1%-7% of biopsies and is usually self-limiting (31)(32)(33)(34)(35). Color Doppler US can easily demonstrate arteriovenous fistulas (AVFs) and pseudoaneurysms as localized areas of disorganized color that extend outside the confines of the normal vessel in the renal parenchyma.…”

Section: Postbiopsy Complicationsmentioning

confidence: 99%

Renal Relevant Radiology

Sharfuddin

2014

Clinical Journal of the American Society of Nephrology

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SummaryKidney transplantation can be associated with various complications that vary from vascular complications to urologic disorders to immunologic adverse effects. In evaluating the recipient with graft dysfunction, clinicians can choose among several imaging modalities, including ultrasonography, nuclear medicine studies, computed tomography, and magnetic resonance imaging. This review discusses the evaluation of the kidney transplant recipient using these imaging procedures, emphasizing the clinical diagnostic utility and role of each modality. A kidney biopsy is often required as a gold standard for diagnostic purposes. However, because of the inherent risks of a kidney biopsy, noninvasive imaging in diagnosing causes of graft dysfunction is a highly desired tool used and needed by the transplant community. Because the diagnostic accuracy varies depending on the time course and nature of the transplant-related complication, this review also addresses the advantages and limitations of each modality. The recent advances in kidney transplant imaging techniques and their clinical implications are also discussed.

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“…Our patient underwent the latter type. The overall reported incidence of bleeding in allograft biopsies varies greatly, ranging from 3 % to 16.5 %, and the reported incidence of symptomatic AVFs is about 0.4 % [ 3 , 10 , 11 ]. The complication rates of graft biopsies compared with native biopsies is a subject of debate.…”

Section: Discussionmentioning

confidence: 99%

Salvage of bleeding renal allograft following biopsy, with suture technique: a case report

et al. 2016

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BackgroundPercutaneous renal biopsy is a valuable procedure in the management of and prognostication for patients with renal disease. Complications, although rare, occur with renal biopsies. Arteriovenous fistulas and heavy bleeding are notable complications. In this report, we describe simple suturing of the biopsy tract for salvage of a graft destined for a nephrectomy due to a profusely bleeding arteriovenous fistula.Case presentationA 20-year-old Sri Lankan man with end-stage renal disease due to steroid-resistant nephrotic syndrome underwent a renal transplant. He had poor urine output following the surgery, and a renal biopsy was performed to diagnose his renal pathology. He experienced poorly controlled postprocedural hypertension, and he had four episodes of gross hematuria that required blood transfusion. Coil embolization was delayed due to technical issues, and a graft nephrectomy was planned following the fourth episode of hematuria, which was the most severe. A Doppler scan revealed a slender, iatrogenic arteriovenous fistula corresponding to the biopsy tract, with very high flow rates. With knowledge of the anatomy of the fistula, we performed suturing of the tract to obliterate the fistula as a last resort to salvage the graft. The surgical procedure stopped the bleeding, and the patient made a full recovery with an excellent quality of life.ConclusionsIn our patient, a renal transplant biopsy revealed acute tubular necrosis. The incidence and treatment of fistulas and differences in complication rates among native and graft kidney biopsies are discussed.

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Kidney allograft biopsy: timing to complications

Cited by 26 publications

References 0 publications

Postoperative surgical-site hemorrhage after kidney transplantation: incidence, risk factors, and outcomes

Postoperative surgical-site hemorrhage after kidney transplantation: incidence, risk factors, and outcomes

Renal Relevant Radiology

Salvage of bleeding renal allograft following biopsy, with suture technique: a case report

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