US-guided renal transplant biopsy: efficacy of a cortical tangential approach.

PURPOSE To describe the cortical tangential approach to ultrasonographically (US) guided renal transplant biopsy and evaluate its efficacy in obtaining sufficient cortical tissue. MATERIALS AND METHODS This HIPAA-compliant retrospective study was exempted from review by the institutional review board. Informed consent was not required. The number of core biopsy samples, glomeruli, and small arteries obtained during 294 consecutive US-guided renal transplant biopsies in 254 patients (134 men, 120 women; age range, 19-79 years; mean age, 52.2 years) in one department between June 1 and December 31, 2008, were recorded, along with any ensuing complications. Procedural success was assessed according to Banff 97 criteria. RESULTS There were 1.2 +/- 0.4 (standard deviation) biopsy core samples taken per case by 11 radiologists using the cortical tangential approach. In 290 cases, biopsy results showed 21.7 +/- 10.1 glomeruli and 5.0 +/- 2.8 small arteries. Two hundred seventy-six (95%) cases were adequate or minimal according to Banff 97 assessment criteria. Of the 14 inadequate cases (5%), six were lacking only one glomerulus to achieve minimal status. Only one biopsy core sample was taken in all 14 inadequate cases and in 233 successful cases (success rate, 85%). None of the 43 cases with two or more biopsy core samples taken were inadequate (success rate, 100%). Two patients (0.7%) had a hemorrhagic complication requiring transfusion, and another four patients (1.4%) experienced a minor self-limiting complication. CONCLUSION The cortical tangential approach can be used by a cohort of radiologists to achieve 95% or higher collective success in obtaining cortical tissue during renal transplant biopsy, with few complications. The success rate is higher, without increased complications, when more than one core specimen is taken.

[1]  Katsuhiro Kobayashi,et al.  Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. , 2007, Radiographics : a review publication of the Radiological Society of North America, Inc.

[2]  T. Beattie,et al.  Renal transplant biopsy specimen adequacy in a paediatric population , 2006, Pediatric Nephrology.

[3]  Anke Schwarz,et al.  Safety and Adequacy of Renal Transplant Protocol Biopsies , 2005, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[4]  A. Schwarz,et al.  Protocol biopsy of the stable renal transplant: a multicenter study of methods and complication rates , 2003, Transplantation.

[5]  M. Sarwal,et al.  Safety and risk stratification of percutaneous biopsies of adult-sized renal allografts in infant and older pediatric recipients , 2003, Transplantation.

[6]  P. Pattynama,et al.  Complication rate and diagnostic yield of 515 consecutive ultrasound-guided biopsies of renal allografts and native kidneys using a 14-gauge Biopty gun , 2003, European Radiology.

[7]  A. Watson,et al.  Standards for renal biopsies: comparison of inpatient and day care procedures , 2002, Pediatric Nephrology.

[8]  R. Moore,et al.  The new Banff classification of renal transplant biopsies: a major impact on the adequacy of the cores taken. , 2001, Transplantation proceedings.

[9]  S. White,et al.  A prospective randomized trial of three different sizes of core-cutting needle for renal transplant biopsy. , 2000, Kidney international.

[10]  H. E. Hansen,et al.  The Banff 97 working classification of renal allograft pathology. , 1999, Kidney international.

[11]  R. Nyman,et al.  Yield and complications in percutaneous renal biopsy , 1997, Acta radiologica.

[12]  P. Bell,et al.  Comparison of three methods to obtain percutaneous needle core biopsies of a renal allograft , 1994, The British journal of surgery.

[13]  J. Riehl,et al.  Percutaneous renal biopsy: comparison of manual and automated puncture techniques with native and transplanted kidneys. , 1994, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[14]  M. Mahoney,et al.  Safety and efficacy of kidney transplant biopsy: Tru-Cut needle vs sonographically guided Biopty gun. , 1993, AJR. American journal of roentgenology.

[15]  P. Allan,et al.  Conventional 15 G needle technique for renal biopsy compared with ultrasound-guided spring-loaded 18 G needle biopsy. , 1992, The British journal of radiology.

[16]  M. Nicholson,et al.  Renal transplant biopsy using real time ultrasound guidance. , 1990, British journal of urology.