Abstract: FR-PO1169
Safety and Efficacy of a Kidney Graft Biopsy Program by Nephrologists with Short Post-Biopsy Surveillance Times
Session Information
- Transplantation: Clinical - Post-Transplant Complications
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Arvizu-Hernandez, Mauricio, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico, Mexico
- Marino-Vazquez, Lluvia A., National Medical Science and Nutrition Institute Salvador Zubirán, Mexico, Mexico
- Mejia, María Fernanda, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico, Mexico
- Fernandez, Dheni, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico, Mexico
- Rendon, Brenda, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico, Mexico
- Estrada, Mariel, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico, Mexico
- Correa-Rotter, Ricardo, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico, Mexico
- Morales-Buenrostro, Luis E., National Medical Science and Nutrition Institute Salvador Zubirán, Mexico, Mexico
Background
Kidney graft biopsies (KGB) are the gold standard for diagnosis of kidney graft dysfunction. Since Jan/2015 we have increased the KGB, reducing wait times and costs, due to the implementation of a ambulatory program (intrahospital surveillance <6 hrs), in charge of the fellows of the transplant nephrology program, supervised and guided by an interventional nephrologist.
Methods
Prospective, observational and descriptive study.
Results
1091 KGB were made (jan/15-dec/18). Indications: protocol 463 (43.8%), de novo or increase of DSA 231 (21.2%), post-rejection control 149 (13.7%), graft dysfunction 146 (13.4%) and others 87 (7.9%).
A total of 33 (3.0%) complications were reported; 5 (0.5%) were serious (persistent hematuria and hospitalization requirement). 11 (1%) were hematuria; 21 (1.9%) peri-graft hematomas. No infections, graft loss, or other procedures were required.
In 1070 KGB (98.1%) the sample was adequate.
Protocolized KGB at 3 and 12 mo post-KT and surveillance KGB for new pts from other centers carried out in 463 cases; 236 at 3 mo, 187 at 12 mo and 40 of newly admitted pts. Spite of not having clinical/laboratories alterations, the result of the KGB was abnormal in 58% of the total; 50% at 3 mo, 63% at 12 mo and 67% in new pts. Findings were: borderline alterations 158 (34%), humoral rejection 44 (9.5%), cellular rejection 24 (5%) and other alterations 36 (7.7%).
In 161 (14%) pts we evaluated the relationship between the angle of incidence of the needle on the renal graft and the quality of sample and complications. The firing angle was 33.1±8.8 degrees, with a median of 12 (8-16 glom). There were no relation between angle of incidence and the quality of sample, or in the probability of complications.
We observed a saving of 75% in each KGB ($680 before 2015 vs $172 after 2015); total savings of $553,855, and a reduction 1091 hospital beds in the 4 yrs.
Conclusion
The implementation of a KGB program by nephrologists reduced costs and hospital stay. It was effective (adequate sample in 98%) and safe (3% complications). In our study there were no serious complications that required invasive procedures, transfusions or graft loss. The angle of shot does not impact on the frequency of complications or the quality of the sample.