title: Low incidence of adverse events in outpatient pediatric renal allograft biopsies.
abstract: In 1999, our center implemented a policy of outpatient protocol biopsies as standard practice for the clinical management of pediatric renal allograft recipients. In order to determine the safety of this procedure, we conducted a retrospective chart audit of all outpatient renal allograft biopsies performed at our center. Biopsies were performed under conscious (midazolam) or procedural (propofol/fentanyl) sedation. Localization of the lower pole of the renal allograft was achieved with renal ultrasound. Using a Biopty gun with a 16-gauge needle, two cores were obtained. Patients were discharged four h post-biopsy. Patient demographics, hospital length of stay (LOS), specimen adequacy (per Banff criteria) and major and minor adverse events were recorded in a central database. Data were expressed as mean +/- SD. From June 1999 to July 2004, we performed 162 biopsies in 43 pediatric renal allograft recipients. Most patients underwent extraperitoneal transplantation (42/43, 97.7%) and were greater than five yr of age at biopsy (129/131 biopsies, 98.5%). The majority of these procedures (131/162, 80.9%) were conducted in the outpatient department, with 113 of 131 (86.3%) being obtained for protocol (n = 89) and one-month follow-up acute rejection therapy (n = 24) indications. Patients underwent 3.7 +/- 2.7 biopsies (range = 1-11). Specimen adequacy was achieved in 119 of 124 (96.0%) of documented cases. The overall incidence of adverse events was 12 of 131 (9.2%) biopsies, all of which were minor in severity. Macroscopic hematuria was the most common minor adverse event, occurring after 11 of 131 (8.4%) biopsies. While macroscopic hematuria prolonged LOS (adverse events vs. no adverse events: 23.0 +/- 26.0 vs. 8.6 +/- 4.1 h, p = 0), none of these episodes required major surgical or radiographic interventions. We conclude that in patients greater than five yr of age with extraperitoneal renal allografts, outpatient protocol biopsies using a 16-gauge needle are sufficiently safe to justify their inclusion in the routine clinical management of pediatric renal allograft recipients and in pediatric clinical trials.
authors.affiliation: Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada. pbirk@hsc.mb.ca
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Birk
authors.forename: Tom D
authors.initials: TD
authors.lastname: Blydt-Hansen
authors.forename: Allison B
authors.initials: AB
authors.lastname: Dart
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kaita
authors.forename: Cynthia
authors.initials: C
authors.lastname: Proulx
authors.forename: Gerald
authors.initials: G
authors.lastname: Taylor
mesh_terms: D000553:Ambulatory Care; D001707:Biopsy, Needle / Q000009:adverse effects; D002648:Child; D016292:Procedural Sedation; D005260:Female; D006417:Hematuria / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D016030:Kidney Transplantation / Q000473:pathology*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014184:Transplantation, Homologous