Complications of Ultrasound‐Guided Renal Transplant Biopsies

Renal transplant biopsies to diagnose transplant pathology are routinely performed using ultrasound guidance. Few large studies have assessed the rate and risk factors of major biopsy complications. This study is a single‐center 5‐year retrospective cohort analysis of 2514 biopsies. Major complications occurred in 47 of 2514 patients (1.9%) and included hospitalization, transfusion of blood products, operative exploration and interventional radiology procedures. The complication rate among “cause” biopsies was significantly higher than in “protocol” biopsies (2.7% vs. 0.33%, p < 0.001). Complications presented on postbiopsy days 0–14, with the majority diagnosed on the same day as the biopsy and manifested by hematocrit drop, although the presence of such delayed presentation of complications occurring >24 h after the biopsy on days 2–14 is previously unreported. Specific patient characteristics associated with increased risk of a complication were increased age and blood urea nitrogen, decreased platelet count, history of prior renal transplant, deceased donor transplant type and use of anticoagulant medications but not aspirin. The authors review the incidence of major complications associated with ultrasound‐guided renal transplant biopsies, including timing, presentation, and association with clinical factors, including patient demographics and prebiopsy laboratory values.