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.
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References
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Whittier WL. Complications of the percutaneous kidney biopsy. Adv Chronic Kidney Dis. 2012;19:179–87.
Raju DS, Rammurti S. Arteriovenous fistula following kidney biopsy. Indian J Nephrol. 2008;18:83–4.
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.
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.
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.
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.
Morgan TA, Chandran S, Burger IM, Zhang CA, Goldstein RB. Complications of ultrasound-guided renal transplant biopsies. Am J Transpl. 2016;16:1298–305.
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.
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.
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.
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Ryuge, A., Yazawa, M., Kitajima, K. et al. Hemorrhagic shock due to bleeding from an arteriovenous fistula after allograft biopsy in a kidney transplant recipient: a case report. CEN Case Rep 7, 5–8 (2018). https://doi.org/10.1007/s13730-017-0279-9
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DOI: https://doi.org/10.1007/s13730-017-0279-9