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2018 ; 28
(ä): 6-10
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A retrospective analysis of the utility and safety of kidney transplant biopsies
by nephrology trainees and consultants
#MMPMID29552340
Reschen ME
; Mazzella A
; Sharples E
Ann Med Surg (Lond)
2018[Apr]; 28
(ä): 6-10
PMID29552340
show ga
BACKGROUND AND AIMS: Dysfunction of a kidney transplant often requires
histological sampling by percutaneous ultrasound-guided core needle biopsy.
Transplant biopsy is more specialized than native kidney biopsy, the indications
and complications are less well defined and in England are performed mainly by
nephrologists. The aims of the study were to evaluate the adequacy and
complication rate in living and deceased donor recipients according to training
status of the nephrologist, assess the accuracy of physicians in predicting
rejection, the threshold creatinine rise for biopsy, and the change in drug
management post-biopsy. MATERIALS AND METHODS: We performed a retrospective
analysis of all adult patients undergoing a kidney transplant biopsy in 2015?at a
major teaching hospital in the UK as part of a service evaluation program. The
primary outcome measure was the rate of major complications and secondary
measures included sample adequacy, seniority of operator, clinician-predicted
diagnosis, biopsy diagnosis and change in drug management. RESULTS: One hundred
and seven (n?=?107) transplant biopsies were performed across 27 living donor
(LD) recipients and 57 deceased donor (DD) recipients. LDs were statistically
less likely to have diabetes, more likely to take azathioprine. Biopsies were
performed by trainees rather than consultants at a ratio of 3:1. The complication
rate was low with no major bleeding complications. Visible haematuria occurred in
4.7% and 2.8% of patients developed transplant pyelonephritis. 3.7% of biopsies
contained no glomeruli. There was no effect attributed to training status. The
pre-biopsy rise in creatinine was significantly less for LD compared to DD
recipients (45% vs 70%). A clinician-suspected diagnosis of rejection was
confirmed on biopsy in 42.9% of cases and overall about 47.9% of biopsies led to
a change in drug management. CONCLUSIONS: Kidney transplant biopsies were safe,
performed adequately by trainee nephrologists and were often associated with a
change in drug management.