Advertisement

Diagnostic efficacy and safety of ultrasound-guided kidney transplant biopsy using cortex-only view: a retrospective single-center study

  • Jaeseung Shin
  • Sung Yoon ParkEmail author
Ultrasound
  • 54 Downloads

Abstract

Purpose

Cortical biopsy is the cornerstone to reveal a cause of unexplained dysfunction of the kidney transplant. Nevertheless, only a few studies have reported the biopsy technique with its performance. We described a novel technique of ultrasound (US)-guided kidney transplant biopsy using cortex-only view and analyzed its diagnostic efficacy and safety.

Materials and methods

Between January 2014 and December 2016, a consecutive series of 188 patients who underwent US-guided kidney transplant biopsy using cortex-only view by an experienced radiologist were evaluated (mean age, 46.1 ± 12.5 years; range, 21–79 years). Biopsy time, biopsy distance, biopsy core number, and glomerular number per patient were recorded. Successful biopsy (e.g., adequate, 10 or more glomeruli; marginal, 7–9 glomeruli) and complication rates were investigated, using Banff criteria and Clavien-Dindo classification, respectively.

Results

Mean biopsy time, distance, and core number were 20.6 ± 6.7 min (range, 10–44 min), 3.2 ± 0.7 cm (range, 2.1–5.4 cm), and 1.9 ± 0.3 (range, 1.0–3.0), respectively. Mean glomerular number per patient was 20.4 ± 10.0 (range, 0–54). Adequate and marginal biopsy rates were 87.2% (164/188) and 95.2% (179/188), respectively. There was no major complication requiring treatment (no patient with Clavien-Dindo grade 2 or greater complication), while there were self-limiting minor complications in 5 patients (overall complication rate, 2.7%).

Conclusion

US-guided biopsy using cortex-only view is feasible and safe in sampling cortical tissues of kidney transplant.

Key Points

• Ultrasound (US)-guided kidney transplant biopsy using cortex-only view is feasible and safe.

• Adequate and marginal biopsy rates were 87.2% and 95.2%, respectively.

• No major complication requiring treatment occurred after biopsy.

Keywords

Kidney Biopsy Transplant Allograft Ultrasonography 

Abbreviations

BMI

Body mass index

US

Ultrasound

Notes

Acknowledgements

The authors would like to thank Dong-Su Jang, MFA, (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for his help with the illustrations.

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Sung Yoon Park, M.D.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Cross sectional study

• Performed at one institution

References

  1. 1.
    Serón D, Moreso F, Bover J et al (1997) Early protocol renal allograft biopsies and graft outcome. Kidney Int 51:310–316PubMedCrossRefGoogle Scholar
  2. 2.
    Williams WW, Taheri D, Tolkoff-Rubin N, Colvin RB (2012) Clinical role of the renal transplant biopsy. Nat Rev Nephrol 8:110–121PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Benjamens S, Glaudemans AWJM, Berger SP, Slart RHJA, Pol RA (2018) Have we forgotten imaging prior to and after kidney transplantation? Eur Radiol 28:3263–3267PubMedCrossRefGoogle Scholar
  4. 4.
    Steiger P, Barbieri S, Kruse A, Ith M, Thoeny HC (2017) Selection for biopsy of kidney transplant patients by diffusion-weighted MRI. Eur Radiol 27:4336–4344PubMedCrossRefGoogle Scholar
  5. 5.
    Al-Awwa IA, Hariharan S, First MR (1998) Importance of allograft biopsy in renal transplant recipients: correlation between clinical and histological diagnosis. Am J Kidney Dis 31:S15–S18PubMedCrossRefGoogle Scholar
  6. 6.
    Ahmad I (2004) Biopsy of the transplanted kidney. Semin Intervent Radiol 21:275–281PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Patel MD, Young SW, Scott Kriegshauser J, Dahiya N (2018) Ultrasound-guided renal transplant biopsy: practical and pragmatic considerations. Abdom Radiol (NY) 43:2597–2603CrossRefGoogle Scholar
  8. 8.
    Patel MD, Phillips CJ, Young SW et al (2010) US-guided renal transplant biopsy: efficacy of a cortical tangential approach. Radiology 256:290–296PubMedCrossRefGoogle Scholar
  9. 9.
    Boban MD, Tiefenthaler M (2017) Tangential extraperitoneal retrorenal approach: a specified uniform technique for renal transplant biopsy. Transpl Int 30:947–950PubMedCrossRefGoogle Scholar
  10. 10.
    Racusen LC, Solez K, Colvin RB et al (1999) The Banff 97 working classification of renal allograft pathology. Kidney Int 55:713–723PubMedCrossRefGoogle Scholar
  11. 11.
    Yoshinari M, Suzuki R, Watanabe K, Katoh T, Watanabe T (2002) How long is enough: length of renal needle biopsy specimen for histological diagnosis. Am J Nephrol 22:402PubMedCrossRefGoogle Scholar
  12. 12.
    Schwarz A, Gwinner W, Hiss M, Radermacher J, Mengel M, Haller H (2005) Safety and adequacy of renal transplant protocol biopsies. Am J Transplant 5:1992–1996PubMedCrossRefGoogle Scholar
  13. 13.
    Preda A, Van Dijk LC, Van Oostaijen JA, Pattynama PM (2003) Complication rate and diagnostic yield of 515 consecutive ultrasound-guided biopsies of renal allografts and native kidneys using a 14-gauge Biopty gun. Eur Radiol 13:527–530PubMedGoogle Scholar
  14. 14.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Nicholson ML, Wheatley TJ, Doughman TM et al (2000) A prospective randomized trial of three different sizes of core-cutting needle for renal transplant biopsy. Kidney Int 58:390–395PubMedCrossRefGoogle Scholar
  16. 16.
    Furness PN, Philpott CM, Chorbadjian MT et al (2003) Protocol biopsy of the stable renal transplant: a multicenter study of methods and complication rates. Transplantation 76:969–973PubMedCrossRefGoogle Scholar
  17. 17.
    Patel MD, Miranda R, Phillips CJ et al (2011) Impact of a quality assessment program on radiologist performance in ultrasound-guided renal transplant biopsy. J Am Coll Radiol 8:355–359PubMedCrossRefGoogle Scholar
  18. 18.
    Laute M, Vanholder R, Voet D et al (2013) Safety and sample adequacy of renal transplant surveillance biopsies. Acta Clin Belg 68:161–165PubMedCrossRefGoogle Scholar
  19. 19.
    Torres-Rodriguez IB, Castella-Fierro E, Serres-Creixans X et al (2014) Safety and efficacy of outpatient biopsy in renal transplantation. Nefrologia 34:749–755PubMedGoogle Scholar
  20. 20.
    Redfield RR, McCune KR, Rao A et al (2016) Nature, timing, and severity of complications from ultrasound-guided percutaneous renal transplant biopsy. Transpl Int 29:167–172PubMedCrossRefGoogle Scholar
  21. 21.
    Morgan TA, Chandran S, Burger IM, Zhang CA, Goldstein RB (2016) Complications of ultrasound-guided renal transplant biopsies. Am J Transplant 16:1298–1305PubMedCrossRefGoogle Scholar
  22. 22.
    Tsai SF, Chen CH, Shu KH et al (2016) Current safety of renal allograft biopsy with indication in adult recipients: an observational study. Medicine (Baltimore) 95:e2816CrossRefGoogle Scholar
  23. 23.
    Beckingham IJ, Nicholson ML, Bell PR (1994) Analysis of factors associated with complications following renal transplant needle core biopsy. Br J Urol 73:13–15PubMedCrossRefGoogle Scholar
  24. 24.
    Bataille S, Jourde N, Daniel L et al (2012) Comparative safety and efficiency of five percutaneous kidney biopsy approaches of native kidneys: a multicenter study. Am J Nephrol 35:387–393PubMedCrossRefGoogle Scholar
  25. 25.
    Hogan JJ, Mocanu M, Berns JS (2016) The native kidney biopsy: update and evidence for best practice. Clin J Am Soc Nephrol 11:354–362PubMedCrossRefGoogle Scholar
  26. 26.
    Boyvat F, Tarhan NC, Coşkun M, Ağildere AM, Tutar NU, Bilgin N (1998) Comparison of two biopsy techniques for renal transplant assessment. Transplant Proc 30:777–779Google Scholar
  27. 27.
    Cozens NJ, Murchison JT, Allan PL, Winney RJ (1992) Conventional 15 G needle technique for renal biopsy compared with ultrasound-guided spring-loaded 18 G needle biopsy. Br J Radiol 65:594–597PubMedCrossRefGoogle Scholar
  28. 28.
    Beland MD, Walle NL, Machan JT, Cronan JJ (2010) Renal cortical thickness measured at ultrasound: is it better than renal length as an indicator of renal function in chronic kidney disease? AJR Am J Roentgenol 195:W146–W149PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea

Personalised recommendations