Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Nephrology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Transplant Proc. 2023 Dec;55(10):2385-2391. doi: 10.1016/j.transproceed.2023.09.016. Epub 2023 Oct 21.
This study compared a novel technique for renal allograft biopsy, color Doppler ultrasound-guided biopsy (CDUS-Bx), with routine ultrasound-guided biopsy (RUS-Bx).
A retrospective review was conducted on 111 patients, with 42 undergoing CDUS-Bx and 69 undergoing RUS-Bx. Urologists used an 18-gauge automatic spring-loaded biopsy needle for all procedures. CDUS-Bx tissue collection was guided by identifying renal vessels with color Doppler mode.
Overall, the adequacy rate was 90.1%, with a higher number of glomeruli obtained in the CDUS-Bx group (25.6 ± 10.3 vs. 20.6 ± 11.3, P = .008). Acute tubular necrosis was the most frequent pathological diagnosis, with a higher prevalence in the CDUS-Bx group (69% vs 40.6%). T cell-mediated rejection had a lower incidence in the CDUS-Bx group (4.8% vs 21.7%), and antibody-mediated rejection was comparable between the 2 groups. The most common complication was microscopic hematuria, which was significantly less frequent in the CDUS-Bx group (48.7% vs 70.1%, P = .028), but there was no significant difference in the rate of gross hematuria between CDUS-Bx and RUS-Bx (11.9% vs 11.6%, P = .961). The number of cores was the only predictor of adequate biopsy, with a 93.2% adequacy rate after 3 cores of allograft biopsy. Multivariate analysis revealed that only the guiding type, CDUS-Bx, was associated with less microscopic hematuria (adjusted odds ratio 0.325, P = .018).
Color Doppler ultrasound-guided biopsy had comparable tissue adequacy to RUS-Bx, with a lower incidence of microscopic hematuria. These findings suggest that CDUS-Bx may be a safe and effective alternative to RUS-Bx for allograft biopsy.
本研究比较了一种新型的肾移植活检技术，即彩色多普勒超声引导活检（CDUS-Bx）与常规超声引导活检（RUS-Bx）。
回顾性分析了 111 例患者，其中 42 例行 CDUS-Bx，69 例行 RUS-Bx。所有患者均采用 18G 自动弹枪式活检针进行操作。CDUS-Bx 组织采集通过彩色多普勒模式识别肾血管进行引导。
总的来说，充足率为 90.1%，CDUS-Bx 组获取的肾小球数量更多（25.6±10.3 比 20.6±11.3，P=0.008）。急性肾小管坏死是最常见的病理诊断，CDUS-Bx 组的发生率更高（69%比 40.6%）。T 细胞介导的排斥反应在 CDUS-Bx 组的发生率较低（4.8%比 21.7%），而抗体介导的排斥反应在两组之间无差异。最常见的并发症是镜下血尿，CDUS-Bx 组明显少于 RUS-Bx 组（48.7%比 70.1%，P=0.028），但 CDUS-Bx 和 RUS-Bx 组的肉眼血尿发生率无显著差异（11.9%比 11.6%，P=0.961）。活检针芯的数量是获得充足组织的唯一预测因素，3 针肾移植活检的充足率为 93.2%。多变量分析显示，只有引导方式，即 CDUS-Bx，与镜下血尿减少相关（调整优势比 0.325，P=0.018）。
彩色多普勒超声引导活检与 RUS-Bx 相比，组织充足率相当，但镜下血尿发生率较低。这些发现表明，CDUS-Bx 可能是替代 RUS-Bx 进行肾移植活检的一种安全有效的方法。
