CEN Case Reports

, Volume 7, Issue 1, pp 5–8 | Cite as

Hemorrhagic shock due to bleeding from an arteriovenous fistula after allograft biopsy in a kidney transplant recipient: a case report

  • Akihiro Ryuge
  • Masahiko Yazawa
  • Kazuki Kitajima
  • Ryuto Nakazawa
  • Hideo Sasaki
  • Tatsuya Chikaraishi
  • Yugo Shibagaki
Case Report
  • 76 Downloads

Abstract

Arteriovenous fistula (AVF) after allograft biopsy occurs in 1.6–8.3% of kidney transplant patients and most cases remain asymptomatic. Here, we report a case of hemorrhagic shock in a kidney transplant recipient following bleeding from an AVF after graft biopsy. Immediate intensive care including angiographic embolization saved the patient and the allograft. A 62-year-old woman with end-stage renal disease caused by diabetic nephropathy underwent ABO-incompatible kidney transplantation. No complications occurred in the early postoperative period. However, serum creatinine levels did not decrease sufficiently and decreased graft diastolic blood flow was noted on ultrasound. Therefore, at 14 days after kidney transplantation, allograft biopsy was performed to elucidate the cause of allograft dysfunction. At 5 days after allograft biopsy, the patient developed hemorrhagic shock caused by bleeding from an AVF in the allograft. We immediately performed angiographic embolization, and her vital signs improved without deterioration in renal function. AVF can cause hemorrhagic shock, and angiographic embolization is effective for treating it.

Keywords

Allograft biopsy Arteriovenous fistula Hemorrhagic shock Angiographic embolization 

Notes

Compliance with ethical standards

Conflict of interest

All the authors have declared no competing interests.

Human and animal rights statement

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in this case report.

Funding

None.

References

  1. 1.
    Nahas WC, Mazzucchi E, Henrique A, Ianhez LE, Saldanha LB, Sabbaga E, et al. Percutaneous needle biopsy of the renal allograft using the automated needle system: evaluation of 87 procedures. J Urol. 1993;150(2 Pt 1):313–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Boschiero LB, Saggin P, Galante O, Prati GF, Dean P, Longo M, et al. Renal needle biopsy of the transplant kidney: vascular and urologic complications. Urol Int. 1992;48:130–3.CrossRefPubMedGoogle Scholar
  3. 3.
    Merkus JW, Zeebregts CJ, Hoitsma AJ, van Asten WN, Koene RA, Skotnicki SH. High incidence of arteriovenous fistula after biopsy of kidney allografts. Br J Surg. 1993;80:310–2.CrossRefPubMedGoogle Scholar
  4. 4.
    Plainfosse MC, Calonge VM, Beyloune-Mainardi C, Glotz D, Duboust A. Vascular complications in the adult kidney transplant recipient. J Clin Ultrasound. 1992;20:517–27.CrossRefPubMedGoogle Scholar
  5. 5.
    Loffroy R, Guiu B, Lambert A, Mousson C, Tanter Y, Martin L, et al. Management of post-biopsy renal allograft arteriovenous fistulas with selective arterial embolization: immediate and long-term outcomes. Clin Radiol. 2008;63:657–65.CrossRefPubMedGoogle Scholar
  6. 6.
    Lorenzen J, Schneider A, Körner K, Regier M, Adam G, Nolte-Ernsting C. Post-biopsy arteriovenous fistula in transplant kidney: treatment with superselective transcatheter embolisation. Eur J Radiol. 2012;81:e721–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Schwarz A, Hiss M, Gwinner W, Becker T, Haller H, Keberle M. Course and relevance of arteriovenous fistulas after renal transplant biopsies. Am J Transpl. 2008;8:826–31.CrossRefGoogle Scholar
  8. 8.
    Deane C, Cowan N, Giles J, Walters H, Rifkin I, Severn A, et al. Arteriovenous fistulas in renal transplants: color Doppler ultrasound observations. Urol Radiol. 1992;13:211–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Voiculescu A, Brause M, Engelbrecht V, Sandmann W, Pfeiffer T, Grabensee B. Hemodynamically relevant hematuria several months after biopsy of a kidney graft: an unusual cause. Clin Nephrol. 2003;59:217–21.CrossRefPubMedGoogle Scholar
  10. 10.
    Tøndel C, Vikse BE, Bostad L, Svarstad E. Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988–2010. Clin J Am Soc Nephrol. 2012;7:1591–7.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Whittier WL. Complications of the percutaneous kidney biopsy. Adv Chronic Kidney Dis. 2012;19:179–87.CrossRefPubMedGoogle Scholar
  12. 12.
    Raju DS, Rammurti S. Arteriovenous fistula following kidney biopsy. Indian J Nephrol. 2008;18:83–4.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Manno C, Strippoli GF, Arnesano L, Bonifati C, Campobasso N, Gesualdo L, et al. Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy. Kidney Int. 2004;66:1570–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Harrison KL, Nghiem HV, Coldwell DM, Davis CL. Renal dysfunction due to an arteriovenous fistula in a transplant recipient. J Am Soc Nephrol. 1994;5:1300–6.PubMedGoogle Scholar
  15. 15.
    Topham PS, Chen Y. Renal biopsy. In: Johnson RH, Feehally J, Floege J, editors. Comprehensive clinical nephrology. 5th ed. Philadelphia: Elsevier; 2015. p. 71–8.Google Scholar
  16. 16.
    Rollino C, Garofalo G, Roccatello D, Sorrentino T, Sandrone M, Basolo B, et al. Colour-coded Doppler sonography in monitoring native kidney biopsies. Nephrol Dial Transpl. 1994;9:1260–3.Google Scholar
  17. 17.
    Morgan TA, Chandran S, Burger IM, Zhang CA, Goldstein RB. Complications of ultrasound-guided renal transplant biopsies. Am J Transpl. 2016;16:1298–305.CrossRefGoogle Scholar
  18. 18.
    Kim MH, Jun KW, Hwang JK, Kim JI, Chung BH, Choi BS, et al. Risk factors for postoperative bleeding in ABO-incompatible kidney transplantation. Clin Transpl. 2015;29:365–72.CrossRefGoogle Scholar
  19. 19.
    Kitajima K, Fuchinoue S, Koyama I, Ishida H, Kimikawa M, Tojimbara T, et al. Embolization for arteriovenous fistula after graft biopsy in renal transplant recipients: is it essential for all cases? Transpl Proc. 2000;32:1911.CrossRefGoogle Scholar
  20. 20.
    Fossaceca R, Guzzardi G, Cerini P, Parziale G, Malatesta E, Di Gesù I, et al. Management of postbiopsy arteriovenous fistulas in transplanted kidneys and effectiveness of endovascular treatment: a single-center experience. Ann Vasc Surg. 2014;28:452–6.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Akihiro Ryuge
    • 1
    • 2
  • Masahiko Yazawa
    • 2
  • Kazuki Kitajima
    • 3
  • Ryuto Nakazawa
    • 3
  • Hideo Sasaki
    • 3
  • Tatsuya Chikaraishi
    • 3
  • Yugo Shibagaki
    • 2
  1. 1.Department of NephrologyNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Nephrology and HypertensionSt. Marianna University School of MedicineKawasakiJapan
  3. 3.Department of UrologySt. Marianna University School of MedicineKawasakiJapan

Personalised recommendations