title: Implementation and Results of a Percutaneous Renal Allograft Biopsy Protocol to Reduce Complication Rate.
abstract: Percutaneous renal transplant biopsy (PRTB) is the gold standard for evaluating allograft rejection after renal transplant. Hemorrhage is the predominant complication. We describe the implementation of a standardized protocol for PRTB at a single institution, with the aim of reducing bleeding complications. Utilizing the plan-do-study-act model for quality improvement, we created and deployed a protocol centered on controlling patient's hypertension, platelet function, and anticoagulation status. The 4-year study encompassed a total of 880 PRTBs, before and after implementation of the protocol. Total complication rate, which was 5.8% in the 2 years leading up to implementation of the protocol, was reduced to 2.9% after the protocol was introduced (P = .04). A standardized approach to PRTB can potentially lower complication rates; we present a framework for implementating a quality improvement protocol at other institutions.
authors.affiliation: Department of Radiology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Li
authors.affiliation: Department of Radiology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Traube
authors.affiliation: Department of Radiology, University of California, Los Angeles, Los Angeles, California.
authors.forename: David S
authors.initials: DS
authors.lastname: Lu
authors.affiliation: Department of Radiology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Raman
authors.affiliation: Department of Nephrology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Danovitch
authors.affiliation: Department of Urology, University of California, Los Angeles, Los Angeles, California.
authors.forename: Hans A
authors.initials: HA
authors.lastname: Gritsch
authors.affiliation: Department of Radiology, University of California, Los Angeles, Los Angeles, California. Electronic address: jumcwilliams@mednet.ucla.edu.
authors.forename: Justin P
authors.initials: JP
authors.lastname: McWilliams
mesh_terms: D005260:Female; D006084:Graft Rejection / Q000175:diagnosis*; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D019106:Postoperative Hemorrhage / Q000175:diagnosis*; D058996:Quality Improvement; D012307:Risk Factors; D014184:Transplantation, Homologous
keywords: Percutaneous renal biopsy; protocol; quality improvement; renal transplant; standardized