Are Pretransplant Kidney Biopsies Safe?

Abstract

Background: Annually, about 500 kidneys are transplanted in Portugal. Despite some studies looking into the procurement biopsies' benefits (like the potential of predicting long term results and establishing a baseline), few have studied its risks, especially in the period between the harvest and the transplant.

Methods: A cross-sectional study, including all patients who received a kidney graft between the 2019 and 2020 at the University Hospital of Coimbra (n = 203). Biopsies were done using a polar double core puncture technique with 18-gauge needles.

Results: Fifty-six patients (27.6%) received a biopsied graft. The median postoperative hemoglobin fall was 2.8 g/dL; this fall was more pronounced in the group that received a biopsied kidney (3.2 g/dL vs 2.6 g/dL; P < .05). The number of transfusions needed during the hospital stay (2.2 U vs 1.3 U; P < .05) and the median length of stay (13.2 ± 8.4 vs 10.6 ± 5.8, P < .05) were greater in the biopsied group. Patients who received a biopsied kidney were older (median age of 57.3 vs 46.9). Cold ischemia time was greater in the biopsied group (19 hours vs 15.2 hours; P < .05). However, we did not find a relation between the age and the hemoglobin drop or blood transfusions. At discharge, renal function was not statistically different between the 2 groups (P was nonsignificant).

Conclusions: Despite the biopsies' potential advantages, they are not without risks. This study showed a statistical association between harvest biopsies and higher risks of hemorrhage, regardless of age. When needed, procurement biopsies seemed safe for the recipients, but at the expense of increased patient surveillance and resource consumption.