CT-guided percutaneous biopsy of pancreas transplants

To evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous needle biopsy in pancreas transplantation patients with graft dysfunction.

Sixty-three CT-guided core biopsies of 42 pancreas grafts were performed with 18-gauge needles over a 38-month period. All but one of the transplants were bladder-drained allografts. An average of 2.25 passes (range, 1-4) per allograft were made, and tissue was immediately processed for histopathologic examination. Fifteen patients (19% of biopsy referrals) could not undergo biopsy because a safe approach was not available.

Of the 63 biopsy specimens, 57(90%) were adequate for histopathologic diagnosis, which was normal or no specific abnormality in 14, acute rejection in 20, chronic rejection in one, chronic rejection with cytomegalovirus inclusion bodies in one, acute or chronic pancreatitis in 13, chronic pancreatitis with cytomegalovirus inclusion bodies in one, and miscellaneous in seven. Three specimens contained no pancreatic tissue, and three were insufficient for diagnosis. Minor complications included a transient rise in serum amylase levels in four patients (6%) and transient mild hematuria in one patient (1%). The only major complication (substantial hemorrhage) occurred in two cases (3%).

CT-guided percutaneous needle biopsy is a safe, alternative method for obtaining tissue in pancreas transplantation patients with graft dysfunction. It may obviate cystoscopic biopsy for bladder-drained grafts or open biopsy in duct-injected or enteric-drained grafts.