A new technique for renal allograft biopsy

Abstract

Renal allograft biopsy may provide diagnostic information and may be of prognostic value. However, percutaneous allograft biopsy may risk haemorrhage, infection and even graft loss (Matas et al, 1985). Various techniques have been described to minimise these risks (Nagar & Wathen, 1979; Appel et al, 1981) but some centres, like our own, have undertaken operative (“open”) allograft biopsy. We present our initial experience of a new technique using an automatic spring-loaded system (Radiplast Biopty, Henleys Medical Supplies Ltd, London) guided by real-time ultrasound to localise accurately the site of biopsy. Forty consecutive biopsies were attempted on 32 renal allografts in 32 patients. Thirty-nine patients were immunosuppressed with cyclosporin (CyA). Biopsies were only performed during episodes of renal dysfunction that could not be clearly identified as acute rejection, CyA nephrotoxicity or acute tubular necrosis. Thirty-two biopsies were performed within 6 weeks of transplantation. Preliminary real-time ultrasonography was performed using an Elscint Dynex Sector Scanner to exclude dilatation of the collecting system and extrarenal fluid collections. The upper pole of the allograft was identified and a biopsy attachment enabled the proposed biopsy line to be projected onto the ultrasound screen. A pathway was chosen so as to maintain the biopsy needle within the cortex of the allograft (Fig. 1). The point of entry (preferably lateral to the skin incision to avoid accidental penetration through the peritoneum) was infiltrated with 1% plain lignocaine and a small skin incision made to permit easier introduction of the biopsy needle.