[Morbidity of percutaneous biopsy of kidney transplants (Vim-Silverman and Tru-cut needles)]

To evaluate the morbidity of renal transplant biopsies performed after simple ultrasonographic identification of the transplants, using a Vim-Silverman or Tru-cut needle.

From January 1987 to April 1991, 360 renal transplant biopsies were performed after simple ultrasonographic identification of the transplants, using a Vim-Silverman (n = 204) or Tru-cut (n-156) needle. In 221 transplants, these biopsies were performed because of a rise of serum creatinine (n = 319) or proteinuria (n = 17) or were even performed systematically (n = 24). One to 5 (mean = 1.6) transplant biopsies were performed systematically and the interval between renal transplantation and biopsy varied between 3 days and 11 years.

290 biopsies (80.6%) allowed the analysis of a minimum of 3 glomeruli (mean = 9.3). The yield of the Vim-Silverman needle was significantly greater than that of the Tru-cut model (p = 0.02). 147 biopsies (50.7%) demonstrated acute or chronic rejection, 57 (19.7%) revealed cyclosporin nephrotoxicity, 41 (14.1%) showed acute tubular necrosis and 14 (4.8%) showed glomerulopathy, while 31 (10.7%) were strictly normal. The morbidity of these biopsies was reflected by 37 complications (10.3%), including 30 minor and 7 major complications (2 cases of haemoperitoneum, 4 cases of obstructive anuria and 1 arteriovenous fistula). However, only one case required transplantectomy. These problems were significantly more frequent following inadequate biopsies (< 3 glomeruli, purely medullary, extra-renal).

Despite the considerable risk of iatrogenic lesions, these biopsies were justified by their potential diagnostic and therapeutic benefit. The prophylaxis of complications of this procedure is based on strict respect of blood pressure and haematological criteria and on real-time ultrasound monitoring of the biopsy and miniaturization of the trocars. The treatment of severe complications has been greatly improved by the development of endourology and interventional radiology, but surgery, and especially transplantectomy, is still occasionally required.