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Pediatric renal transplant biopsy with ultrasound guidance: the ‘core’ essentials

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Abstract

This review provides a comprehensive and practical approach to pediatric percutaneous renal transplant biopsies, highlighting techniques and strategies to optimize adequate sample yield and ensure patient safety. In children with end-stage renal disease, transplantation is the preferred choice of therapy, providing for overall lower long-term morbidity and mortality compared with dialysis. In the ongoing management of renal transplant patients, core tissue sampling via a percutaneous renal biopsy remains the gold standard when transplant dysfunction is suspected. Indications for renal transplant biopsy and techniques/tools for adequate sample yield are discussed. Strategies for common challenges such as poor visualization and renal transplant mobility are addressed. We discuss the clinical signs, techniques and imaging findings for common complications including hematomas, arteriovenous fistulas and pseudoaneurysms. Although the percutaneous renal transplant biopsy procedure is generally safe with rare complications, care must be taken to ensure major complications are promptly recognized and treated. Adequate tissue samples obtained via renal biopsy are imperative to promptly identify transplant rejection to provide valuable information for patient diagnosis, treatment and outcomes. Radiologist and nephrologist attention to proper ultrasound techniques and optimal biopsy tools are critical to ensure tissue adequacy and minimize complications.

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Acknowledgements

The authors wish to thank Jeffery Yang for his assistance with the biopsy core photo.

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, University of California, 550 16th St., 5th floor, Mailstop 3214, San Francisco, CA, 94143- 3214, USA

    Aris Oates & Marsha M. Lee

  2. Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA

    Saveen Ahuja, Andrew S. Phelps, John D. Mackenzie & Jesse L. Courtier

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  1. Aris Oates
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  2. Saveen Ahuja
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Correspondence to Aris Oates.

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Conflicts of interest

Dr. Mackenzie has received research support from General Electric Healthcare. Drs. Oates, Ahuja, Lee, Phelps and Courtier report no conflicts of interest.

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Oates, A., Ahuja, S., Lee, M.M. et al. Pediatric renal transplant biopsy with ultrasound guidance: the ‘core’ essentials. Pediatr Radiol 47, 1572–1579 (2017). https://doi.org/10.1007/s00247-017-3905-y

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  • DOI: https://doi.org/10.1007/s00247-017-3905-y

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