Course and Relevance of Arteriovenous Fistulas After Renal Transplant Biopsies

• Published in: American journal of transplantation Vol. 8; no. 4; pp. 826 - 831
• Main Authors: Schwarz, A., Hiss, M., Gwinner, W., Becker, T., Haller, H., Keberle, M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2008; Blackwell
• Subjects: Arteriovenous Fistula - diagnostic imaging; Arteriovenous Fistula - epidemiology; Arteriovenous Fistula - pathology; Arteriovenous Fistula - therapy; Arteriovenous fistulas; Biological and medical sciences; Biopsy; biopsy complication; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Embolization, Therapeutic; Humans; Kidney Transplantation - pathology; Medical sciences; Outpatients; Pancreas Transplantation - immunology; Pancreas Transplantation - pathology; Postoperative Complications - epidemiology; Postoperative Complications - pathology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Remission, Spontaneous; renal transplant biopsy; renal transplantation; Retrospective Studies; Risk Factors; selective embolization; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Ultrasonography, Doppler; renal transplant biopsy; renal transplantation; Instrumentation therapy; Cardiovascular disease; Homotransplantation; Congenital disease; Kidney; Venous disease; Arteriovenous fistulas; Arterial disease; Vascular disease; Relevance; Anatomic pathology; Arteriovenous aneurysm; Urinary system; Biopsy; Surgery; Graft; Complication; Embolization; biopsy complication; Arteriovenous malformation; selective embolization; Kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2008.02160.x

Arteriovenous fistulas (AVFs) after renal transplant biopsy are considered harmless. However, verification of the clinical course has not been thoroughly documented. We evaluated the data of our outpatient renal transplant biopsy program regarding the clinical course of AVFs after 2824 biopsies since 2000. We also reviewed all selective renal transplant embolizations. AVFs were the most frequent biopsy complications (8.3%). Seventy‐seven percent of AVFs disappeared spontaneously. Renal function in patients with AVFs was not different compared to those without during 2 years of observation. There were no differences in AVFs comparing protocol or indication biopsies, needle size, the time after transplantation, the use of acetylic salicylic acid or serum‐creatinine at biopsy. Living or younger donors were less likely to get postbiopsy AVFs. Ten embolizations were performed. Only one patient was from our outpatient biopsy program. Nine others were biopsied as inpatients in the course of complications during 6 weeks after transplant. Six of nine successfully embolized patients profited with improvement of renal function. Large AVFs occur most commonly shortly after transplantation in patients with poor graft function. There is no established test predicting which patient will benefit from embolization; however, Doppler‐determined resistive index may help in this regard. In 2824 biopsies since the year 2000, arteriovenous fistula occurred in 8.3%, of which 10 required embolization.