Abstract: SA-PO476
Ultrasound and CT Guided Kidney Transplant Biopsies: Evaluating Complications
Session Information
- Transplantation: Balancing Rejection and Infection
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Cortesi, Camilo, University of Miami/Jackson Memorial Hospital, Miami, Florida, United States
- Carias martinez, Karla G, Jackson Health System, Miami, Florida, United States
- Sedki, Mai, University of Miami/Jackson Memorial Hospital, Miami, Florida, United States
- Guerra, Giselle, University of Miami/Miller School of Medicine, Miami, Florida, United States
- Roth, David, University of Miami Miller School of Medicine, Miami, Florida, United States
- Mattiazzi, Adela D., None, Miami, Florida, United States
Background
Kidney transplant (KT) rejection is one of the main indications for KT biopsy (KTb). The ultrasound (US)-guided approach is the preferred method however the computed tomography (CT)-guided approach offers an excellent alternative when the yield is low. We sought to evaluate the incidence of complications in both techniques.
Methods
We identified 646 KTb performed to rule out rejection, 32 of those were CT-guided and the rest US-guided. Retrospective chart review was performed. Complications were divided into moderate and severe where moderate complications included: hematoma, hydronephrosis, arteriovenous fistula, hemoglobin drop >2 g/dL, and need for blood transfusions; severe included the former events associated with a kidney dysfunction, Page kidney or the need for nephrectomy. Descriptive analysis was used for the CT-KTb and a logistic regression was conducted for the US-KTb.
Results
The logistic regression was statistically significant, indicating that the predictors as a set did reliably predict complication occurrence (chi square=51.044, p<0.05, df=34). Prediction success overall was 91.2%. The Wald criterion demonstrated that blood pressure control, BUN, and use of anticoagulants prior to biopsy had a statistically significant impact in predicting complications (p=0.015, p=0.001, p=0.027, respectively). Patients on anticoagulants prior to biopsy were 4 times as likely to have complications (odds ratio 4.167). In CT-KTb only one patient had complications. This patient had uncontrolled blood pressure, BMI > 35, platelet count of 93K/uL and INR was 1.21 at the time of biopsy.
Conclusion
Our data shows that uncontrolled blood pressure, defined as >160/90, uremia, and anticoagulant use were the main predictors of negative outcomes. The presence of these risk factors, particularly in combination, could be of great value in weighing the necessity of a procedure. Additionally, CT-KTb was shown to be a safe alternative for obtaining renal tissue. We highlight the need to achieve adequate control of blood pressure prior to KTb.
Demographics
| US-KTb | CT-KTb | |
| Age Gender n (%) Uncontrolled HTN n (%) Anticoagulation n (%) | 52.7 ± 15 273 (40%) female 163 (24%) 40 (6%) | 57 ± 15.8 13 (41%) female 8 (25%) 14 (44%) |
| BUN - mg/dL Creatinine - mg/dL Platelets - K/uL INR | 38 ± 22 2.71 ± 2.03 215 ± 83 0.99 ± 0.12 | 54 ± 25 3.66 ± 2.84 200 ± 100 1 ± 0.25 |
| Complications n (%) | 78 (12%) moderate 11 (2%) major | 2 (6%) moderate 1 (3%) major |
| Time between biopsy and complication in days | 11.1 ± 38.4 | 2 |
Format is mean ± SE unless otherwise specified