Arteriovenous fistulas after ultrasound-guided needle biopsy of kidney allografts and treatment outcomes after transcatheter embolization: A single-center experience in Japan



Arteriovenous fistula (AVF) is one of the vascular complications after allograft biopsy, and their reported incidence rates range widely. Transcatheter embolization (TE) is a common AVF treatment in kidney allografts. However, information on AVF incidence and features and TE outcomes in Japanese kidney transplant (KT) recipients is lacking.


This study investigated 270 protocol or clinically indicated kidney allograft biopsies in 129 KT recipients during 2010–2016 at a single-center using standardized methods (16-gauge needle and ultrasound guidance). We recorded the incidence and clinical features of AVF using currently recommended standardized methods of allograft biopsy and TE outcomes regarding allograft function up to 12 months after the procedure in Japanese KT recipients.


AVF incidence was 2.6% (seven cases). The time from biopsy to AVF diagnosis was 7 (median, interquartile range: 5–117, range: 1–318) days. The time from biopsy to AVF diagnosis was significantly shorter in symptomatic cases (gross hematuria) than in asymptomatic cases (median 6 vs. 117 days, p = 0.034). Symptomatic patients underwent TE within a shorter time (0–6 days) than asymptomatic patients (25–104 days). There were no complications, and allograft function was stable up to 12 months after TE despite using contrast media and partial renal infarction.


AVF does occur in certain probabilities. AVF formation can occur without apparent bleeding and exist for a long time after allograft biopsy. TE is a safe and immediate treatment for AVF in kidney allograft.

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The results of this paper have not been published previously in whole or part. We sincerely thank Ms. Yoshiko Ono, Ms. Mie Tagaya, and Ms. Mami Ohori, data administrators, for cooperation of this study.

Author information




All authors contributed to conception and design of the study and approved the final version of the manuscript. K.O., and M.Y. collected the clinical data and performed the analysis K.O., and M.Y. also wrote the manuscript. M.Y. takes responsibility for the data and analysis accuracy and all other aspect the work.

Corresponding author

Correspondence to Masahiko Yazawa.

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All the authors have declared no competing interest.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional review committee of St. Marianna University School of Medicine where the study was conducted (IRB approval number No. 3618) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was waived in this study because of the retrospective and observational design.

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Osako, K., Yazawa, M., Terashita, M. et al. Arteriovenous fistulas after ultrasound-guided needle biopsy of kidney allografts and treatment outcomes after transcatheter embolization: A single-center experience in Japan. Clin Exp Nephrol (2020).

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  • Allograft
  • Arteriovenous fistulas
  • Biopsy
  • Kidney transplantation
  • Therapeutic embolization
  • Transcatheter embolization