Association between Age of Kidney Transplant and Hemorrhagic Adverse Events Following Transplant Kidney Biopsy.

Purpose: To identify factors associated with hemorrhagic adverse events requiring secondary intervention after ultrasound (US)-guided or computed tomography (CT)-guided transplant kidney biopsy.

Materials and methods: A retrospective analysis of 1,017 patients who underwent transplant kidney biopsy between January 2019 and August 2023 was conducted. Data collected included patient demographics, age of kidney transplant at biopsy, number of cores sampled, serum creatinine levels, medication use, and hemorrhagic adverse events (AEs). AEs were graded using the Society of Interventional Radiology (SIR) classification system. Outcomes were analyzed on the basis of graft age at the time of biopsy.

Results: Among 1,017 biopsies, 34 hemorrhagic AEs were recorded. Severe hemorrhagic AEs, defined as those requiring secondary intervention, occurred in 1% (10 of 1,017) of cases, with a significantly higher incidence in the ≤90-day graft group than in the >90-day graft group (1.57% [8 of 509] vs 0.39% [2 of 508], P = .04). Mild hemorrhagic AEs, managed conservatively, were observed in 2.4% (24 of 1,017) of cases, with no significant difference between the ≤90-day group (1.77% [9 of 509]) and the >90-day group (2.95% [15 of 508], P = .24). No graft failures were reported during the study period. The median time from biopsy to surgical evacuation for severe AEs was 3.5 hours (interquartile range, 2.8-5.1 hours).

Conclusions: Biopsies performed within 90 days after transplantation were associated with a significantly increased risk of severe hemorrhagic AEs requiring secondary intervention. These findings underscore the need for careful risk stratification and precautionary measures when performing transplant kidney biopsies in early grafts.