Diagnostic efficacy and safety of ultrasound-guided kidney transplant biopsy using cortex-only view: a retrospective single-center study



Cortical biopsy is the cornerstone to reveal a cause of unexplained dysfunction of the kidney transplant. Nevertheless, only a few studies have reported the biopsy technique with its performance. We described a novel technique of ultrasound (US)-guided kidney transplant biopsy using cortex-only view and analyzed its diagnostic efficacy and safety.

Materials and methods

Between January 2014 and December 2016, a consecutive series of 188 patients who underwent US-guided kidney transplant biopsy using cortex-only view by an experienced radiologist were evaluated (mean age, 46.1 ± 12.5 years; range, 21–79 years). Biopsy time, biopsy distance, biopsy core number, and glomerular number per patient were recorded. Successful biopsy (e.g., adequate, 10 or more glomeruli; marginal, 7–9 glomeruli) and complication rates were investigated, using Banff criteria and Clavien-Dindo classification, respectively.


Mean biopsy time, distance, and core number were 20.6 ± 6.7 min (range, 10–44 min), 3.2 ± 0.7 cm (range, 2.1–5.4 cm), and 1.9 ± 0.3 (range, 1.0–3.0), respectively. Mean glomerular number per patient was 20.4 ± 10.0 (range, 0–54). Adequate and marginal biopsy rates were 87.2% (164/188) and 95.2% (179/188), respectively. There was no major complication requiring treatment (no patient with Clavien-Dindo grade 2 or greater complication), while there were self-limiting minor complications in 5 patients (overall complication rate, 2.7%).


US-guided biopsy using cortex-only view is feasible and safe in sampling cortical tissues of kidney transplant.

Key Points

• Ultrasound (US)-guided kidney transplant biopsy using cortex-only view is feasible and safe.

• Adequate and marginal biopsy rates were 87.2% and 95.2%, respectively.

• No major complication requiring treatment occurred after biopsy.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Change history

  • 04 February 2019

    The original version of this article, published on 17 December 2018, unfortunately contained a mistake. The following correction has therefore been made in the original: The name of Jaeseung Shin was presented incorrectly. The corrected author list is given above.



Body mass index




  1. 1.

    Serón D, Moreso F, Bover J et al (1997) Early protocol renal allograft biopsies and graft outcome. Kidney Int 51:310–316

    Article  PubMed  Google Scholar 

  2. 2.

    Williams WW, Taheri D, Tolkoff-Rubin N, Colvin RB (2012) Clinical role of the renal transplant biopsy. Nat Rev Nephrol 8:110–121

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Benjamens S, Glaudemans AWJM, Berger SP, Slart RHJA, Pol RA (2018) Have we forgotten imaging prior to and after kidney transplantation? Eur Radiol 28:3263–3267

    Article  PubMed  Google Scholar 

  4. 4.

    Steiger P, Barbieri S, Kruse A, Ith M, Thoeny HC (2017) Selection for biopsy of kidney transplant patients by diffusion-weighted MRI. Eur Radiol 27:4336–4344

    Article  PubMed  Google Scholar 

  5. 5.

    Al-Awwa IA, Hariharan S, First MR (1998) Importance of allograft biopsy in renal transplant recipients: correlation between clinical and histological diagnosis. Am J Kidney Dis 31:S15–S18

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Ahmad I (2004) Biopsy of the transplanted kidney. Semin Intervent Radiol 21:275–281

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Patel MD, Young SW, Scott Kriegshauser J, Dahiya N (2018) Ultrasound-guided renal transplant biopsy: practical and pragmatic considerations. Abdom Radiol (NY) 43:2597–2603

    Article  Google Scholar 

  8. 8.

    Patel MD, Phillips CJ, Young SW et al (2010) US-guided renal transplant biopsy: efficacy of a cortical tangential approach. Radiology 256:290–296

    Article  PubMed  Google Scholar 

  9. 9.

    Boban MD, Tiefenthaler M (2017) Tangential extraperitoneal retrorenal approach: a specified uniform technique for renal transplant biopsy. Transpl Int 30:947–950

    Article  PubMed  Google Scholar 

  10. 10.

    Racusen LC, Solez K, Colvin RB et al (1999) The Banff 97 working classification of renal allograft pathology. Kidney Int 55:713–723

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Yoshinari M, Suzuki R, Watanabe K, Katoh T, Watanabe T (2002) How long is enough: length of renal needle biopsy specimen for histological diagnosis. Am J Nephrol 22:402

    Article  PubMed  Google Scholar 

  12. 12.

    Schwarz A, Gwinner W, Hiss M, Radermacher J, Mengel M, Haller H (2005) Safety and adequacy of renal transplant protocol biopsies. Am J Transplant 5:1992–1996

    Article  PubMed  Google Scholar 

  13. 13.

    Preda A, Van Dijk LC, Van Oostaijen JA, Pattynama PM (2003) Complication rate and diagnostic yield of 515 consecutive ultrasound-guided biopsies of renal allografts and native kidneys using a 14-gauge Biopty gun. Eur Radiol 13:527–530

    PubMed  Google Scholar 

  14. 14.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Nicholson ML, Wheatley TJ, Doughman TM et al (2000) A prospective randomized trial of three different sizes of core-cutting needle for renal transplant biopsy. Kidney Int 58:390–395

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Furness PN, Philpott CM, Chorbadjian MT et al (2003) Protocol biopsy of the stable renal transplant: a multicenter study of methods and complication rates. Transplantation 76:969–973

    Article  PubMed  Google Scholar 

  17. 17.

    Patel MD, Miranda R, Phillips CJ et al (2011) Impact of a quality assessment program on radiologist performance in ultrasound-guided renal transplant biopsy. J Am Coll Radiol 8:355–359

    Article  PubMed  Google Scholar 

  18. 18.

    Laute M, Vanholder R, Voet D et al (2013) Safety and sample adequacy of renal transplant surveillance biopsies. Acta Clin Belg 68:161–165

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Torres-Rodriguez IB, Castella-Fierro E, Serres-Creixans X et al (2014) Safety and efficacy of outpatient biopsy in renal transplantation. Nefrologia 34:749–755

    PubMed  Google Scholar 

  20. 20.

    Redfield RR, McCune KR, Rao A et al (2016) Nature, timing, and severity of complications from ultrasound-guided percutaneous renal transplant biopsy. Transpl Int 29:167–172

    Article  PubMed  Google Scholar 

  21. 21.

    Morgan TA, Chandran S, Burger IM, Zhang CA, Goldstein RB (2016) Complications of ultrasound-guided renal transplant biopsies. Am J Transplant 16:1298–1305

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Tsai SF, Chen CH, Shu KH et al (2016) Current safety of renal allograft biopsy with indication in adult recipients: an observational study. Medicine (Baltimore) 95:e2816

    Article  Google Scholar 

  23. 23.

    Beckingham IJ, Nicholson ML, Bell PR (1994) Analysis of factors associated with complications following renal transplant needle core biopsy. Br J Urol 73:13–15

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Bataille S, Jourde N, Daniel L et al (2012) Comparative safety and efficiency of five percutaneous kidney biopsy approaches of native kidneys: a multicenter study. Am J Nephrol 35:387–393

    Article  PubMed  Google Scholar 

  25. 25.

    Hogan JJ, Mocanu M, Berns JS (2016) The native kidney biopsy: update and evidence for best practice. Clin J Am Soc Nephrol 11:354–362

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Boyvat F, Tarhan NC, Coşkun M, Ağildere AM, Tutar NU, Bilgin N (1998) Comparison of two biopsy techniques for renal transplant assessment. Transplant Proc 30:777–779

  27. 27.

    Cozens NJ, Murchison JT, Allan PL, Winney RJ (1992) Conventional 15 G needle technique for renal biopsy compared with ultrasound-guided spring-loaded 18 G needle biopsy. Br J Radiol 65:594–597

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Beland MD, Walle NL, Machan JT, Cronan JJ (2010) Renal cortical thickness measured at ultrasound: is it better than renal length as an indicator of renal function in chronic kidney disease? AJR Am J Roentgenol 195:W146–W149

    Article  PubMed  Google Scholar 

Download references


The authors would like to thank Dong-Su Jang, MFA, (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for his help with the illustrations.


The authors state that this work has not received any funding.

Author information



Corresponding author

Correspondence to Sung Yoon Park.

Ethics declarations


The scientific guarantor of this publication is Sung Yoon Park, M.D.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Cross sectional study

• Performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original version of this article was revised: The name of Jaeseung Shin was presented incorrectly.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Shin, J., Park, S.Y. Diagnostic efficacy and safety of ultrasound-guided kidney transplant biopsy using cortex-only view: a retrospective single-center study. Eur Radiol 29, 5272–5279 (2019). https://doi.org/10.1007/s00330-018-5910-4

Download citation


  • Kidney
  • Biopsy
  • Transplant
  • Allograft
  • Ultrasonography