Morgan T A, Chandran S, Burger I M, Zhang C A, Goldstein R B
Department of Radiology and Biomedical Imaging, Univeristy of California San Francisco, San Francisco, CA.
Kidney Transplant Service, Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA.
Am J Transplant. 2016 Apr;16(4):1298-305. doi: 10.1111/ajt.13622. Epub 2016 Jan 25.
Renal transplant biopsies to diagnose transplant pathology are routinely performed using ultrasound guidance. Few large studies have assessed the rate and risk factors of major biopsy complications. This study is a single-center 5-year retrospective cohort analysis of 2514 biopsies. Major complications occurred in 47 of 2514 patients (1.9%) and included hospitalization, transfusion of blood products, operative exploration and interventional radiology procedures. The complication rate among "cause" biopsies was significantly higher than in "protocol" biopsies (2.7% vs. 0.33%, p < 0.001). Complications presented on postbiopsy days 0-14, with the majority diagnosed on the same day as the biopsy and manifested by hematocrit drop, although the presence of such delayed presentation of complications occurring >24 h after the biopsy on days 2-14 is previously unreported. Specific patient characteristics associated with increased risk of a complication were increased age and blood urea nitrogen, decreased platelet count, history of prior renal transplant, deceased donor transplant type and use of anticoagulant medications but not aspirin.
用于诊断移植病理的肾移植活检通常在超声引导下进行。很少有大型研究评估活检主要并发症的发生率及危险因素。本研究是一项对2514例活检进行的单中心5年回顾性队列分析。2514例患者中有47例（1.9%）发生了主要并发症，包括住院治疗、输注血液制品、手术探查和介入放射学操作。“病因”活检的并发症发生率显著高于“方案”活检（2.7%对0.33%，p<0.001）。并发症出现在活检后0至14天，大多数在活检当天被诊断出来，表现为血细胞比容下降，不过此前未报告过在活检后第2至14天出现的此类延迟性并发症（即活检后>24小时出现）。与并发症风险增加相关的特定患者特征包括年龄增加、血尿素氮升高、血小板计数降低、既往肾移植病史、已故供体移植类型以及使用抗凝药物（但不包括阿司匹林）。
