Transvenous Renal Transplant Biopsy via a Transfemoral Approach

Abstract

Percutaneous renal biopsy (PRB) of kidney transplants might be prevented by an elevated risk of bleeding or limited access to the allograft. In the following, we describe our initial experience with 71 transvenous renal transplant biopsies in 53 consecutive patients with unexplained reduced graft function who were considered unsuitable candidates for PRB (4.2% of all renal transplant biopsies at our institution). Biopsies were performed via the ipsilateral femoral vein with a renal biopsy set designed for transjugular renal biopsy (TJRB) of native kidneys. Positioning of the biopsy system within the transplant vein was achievable in 58 of 71 (81.7%) procedures. The specimen contained a median of 10 glomeruli (range 0-38). Tissue was considered as adequate for diagnosis in 56 of 57 (98.2%) biopsies. With respect to BANFF 50.9% of the specimen were adequate (>10 glomeruli), 47.4% marginally adequate (1-9 glomeruli) and 1.8% inadequate (no glomeruli). After implementation of realtime assessment all specimen contained glomeruli. One of the fifty-eight (1.8%) procedure-related major complications occurred (hydronephrosis requiring nephrostomy due to gross hematuria). Transfemoral renal transplant biopsy (TFRTB) is feasible and appears to be safe compared to PRB. It offers a useful new alternative for histological evaluation of graft dysfunction in selected patients with contraindications to PRB.

Tangential Extraperitoneal Retrorenal approach: a specified uniform technique for renal transplant biopsy

“…When performing two biopsy passes, good diagnostic efficacy could be achieved with the TER approach (93.1%). In other PRTB studies, the rates of adequate samples as per Banff criteria ranged from 54.9% to 96.0% [6,13]. To date, two studies have reported higher specimen adequacy than ours [1,13].…”

“…By use of Doppler ultrasound, 12 AVF were detected (4.6%) neither of which required embolization. Our complication rates can be compared to historical data in Table 1 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Sample adequacy could be retrospectively assessed for 156 tissue core samples.…”

Transcaval core biopsy in malignant superior vena cava obstruction: Potential for single stage diagnosis and treatment

“…Intravascular ultrasound (IVUS) is already used in a range of transvenous renal and hepatic interventions …”

“…18 Intravascular ultrasound (IVUS) is already used in a range of transvenous renal and hepatic interventions. 19,20 In conclusion, provided adequate tumour volume and anatomy transvenous core biopsy may provide a safe and effective alternative to mediastinoscopic, bronchoscopic or CT guided biopsy. Procedures can be performed via the transfemoral or transjugular route.…”

Arteriovenous Fistula Complicating Transjugular Renal Biopsy

“…Transjugular renal biopsy provides an alternative to the percutaneous route in patients with contraindications including, most commonly, bleeding diathesis [1]. The procedure has been shown to provide adequate an pathologic specimen and is associated with a complication rate on par with the traditional percutaneous method [2] [3]. Despite being well documented as a consequence of percutaneous biopsy, arteriovenous fistulas (AVFs) are relatively infrequently discussed in the context of a transvenous approach.…”