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Use of Ultrasound and Cystoscopically Guided Pancreatic Allograft Biopsies and Transabdominal Renal Allograft Biopsies: Safety and Efficacy in Kidney-Pancreas Transplant Recipients

1995; Lippincott Williams & Wilkins; Volume: 153; Issue: 2 Linguagem: Inglês

10.1097/00005392-199502000-00005

1527-3792

Christian S. Kuhr, Connie L. Davis, Darlene Barr, John P. McVicar, James D. Perkins, Carlos E. Bachi, Charles E. Alpers, Christopher L. Marsh,

Transplantation: Methods and Outcomes

No AccessJournal of UrologyClinical Urology: Original Article1 Feb 1995Use of Ultrasound and Cystoscopically Guided Pancreatic Allograft Biopsies and Transabdominal Renal Allograft Biopsies: Safety and Efficacy in Kidney-Pancreas Transplant Recipients Christian S. Kuhr, Connie L. Davis, Darlene Barr, John P. McVicar, James D. Perkins, Carlos E. Bachi, Charles E. Alpers, and Christopher L. Marsh Christian S. KuhrChristian S. Kuhr , Connie L. DavisConnie L. Davis , Darlene BarrDarlene Barr , John P. McVicarJohn P. McVicar , James D. PerkinsJames D. Perkins , Carlos E. BachiCarlos E. Bachi , Charles E. AlpersCharles E. Alpers , and Christopher L. MarshChristopher L. Marsh View All Author Informationhttps://doi.org/10.1097/00005392-199502000-00005AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail The use of allograft biopsies to guide treatment after solid organ transplantation is a valuable tool in the detection and treatment of rejection. Prior development and use of the cystoscopically guided pancreatic allograft biopsy have allowed for more accurate and timely diagnosis of pancreatic allograft dysfunction, possibly contributing to our 1-year pancreas graft, renal allograft and patient survival rates of 87.1%, 88.5% and 96.8%, respectively. We reviewed our experience, examining efficacy and complication rates of pancreas and kidney biopsies in 31 cadaveric pancreas or combined kidney and pancreas transplants performed between June 1990 and February 1992 with at least 1 year of followup. There were 94 pancreas, 54 kidney and 53 duodenal mucosal biopsies in 29 evaluable patients. This biopsy technique uses a 24.5F side-viewing nephroscope to view the cystoduodenostomy, with the duodenum acting as a portal for biopsy needles into the pancreas. Pancreatic tissue is obtained with either an 18 gauge, 500 mm. Menghini aspiration/core needle or an 18 gauge, 500 mm. Roth core needle. Percutaneous renal allograft biopsies are performed independently or simultaneously with the pancreas biopsies using a 16 gauge spring loaded needle. Pancreas biopsies were prompted by clinical indications of rejection (decreased urinary amylase, increased serum amylase or increased serum creatinine) or by protocol (10, 21 and 40 days postoperatively). Among the biopsies 30% were required by protocol, of which 10 (36%) revealed abnormal pathological findings and 5 (18%) showed evidence of occult cellular rejection. Renal biopsies demonstrated rejection in 69% of the cases. Of simultaneous pancreas/kidney biopsies 33% revealed concomitant rejection. A total of 88 Menghini needles with 170 passes was used in 73 biopsy attempts, yielding 126 tissue cores with a 16% complication rate. A total of 41 Roth needles was used with 73 passes in 34 biopsy attempts, yielding 55 tissue cores with a complication rate of 21%. Complications included self-limited bleeding from the biopsy site in 13% of the cases, bleeding requiring clot evacuation and fulguration in 1% and asymptomatic hyperamylasemia in 12%. Renal biopsy complications included 1 arteriovenous fistula (2%). We conclude that ultrasound and cystoscopically guided pancreatic allograft biopsy and percutaneous renal allograft biopsies are safe and essential methods of obtaining tissue for histological diagnosis without serious sequelae. The Menghini and Roth needles in cystoscopically guided pancreatic allograft biopsy have similar yield and complication rates in obtaining pancreatic tissue, although they require different performance techniques. In some cases both needles are necessary and are complementary in obtaining adequate tissue. Duodenal biopsies can correlate with pancreatic rejection but are preferable only when pancreatic tissue cannot be obtained. Protocol biopsies are useful in managing kidney and pancreas allografts with surveillance by histological investigation for evidence of allograft rejection or nephrotoxicity. Urologists who treat pancreas transplant patients should be aware of the cystoscopically guided pancreatic allograft biopsy technique. References 1 : Orthotopic liver transplantation: a pathological study of 63 serial liver biopsies from 17 patients with special reference to the diagnostic features and natural history of rejection. Hepatology1984; 4: 1212. Google Scholar 2 : The value of needle renal allograft biopsy. III. A prospective study. Surgery1985; 98: 922. Google Scholar 3 : Pancreas transplantation: an immunohistologic and histopathologic examination of 100 grafts. Amer. J. Path.1963; 128: 151. Google Scholar 4 : Cystoscopically directed biopsy technique in canine pancreaticoduodenal transplantation. Transplant. Proc.1989; 21: 2816. part 3. Google Scholar 5 : Perioperative transduodenal biopsy of the pancreas. Gut1979; 20: 992. Google Scholar 6 : Evaluation of pancreatic biopsy. Ann. Surg.1963; 158: 1053. Google Scholar 7 : The risk and accuracy of pancreatic biopsy. Amer. J. Surg.1976; 132: 189. Google Scholar 8 : Experimental and clinical experience with urine amylase monitoring for early diagnosis of rejection in pancreas transplantation. Transplantation1987; 43: 73. Google Scholar 9 : Differential diagnosis of hypoamylasuria in pancreas allograft recipients with urinary exocrine drainage. Transplantation1990; 59: 359. Google Scholar 10 : Is urinary amylase a reliable index for monitoring whole pancreas endocrine graft function?. Transplant. Proc.1992; 24: 925. Google Scholar 11 : International pancreas transplant registry analysis. Transplant. Proc.1990; 22: 571. Google Scholar 12 : A cystoscopically directed biopsy technique developed in canine pancreaticoduodenal transplantation. Surgery1990; 107: 177. Google Scholar 13 : Safety and efficacy of cystoscopically directed biopsy in pancreas transplantation. Transplant. Proc.1990; 22: 665. Google Scholar 14 : The value of cystoscopically directed biopsy in human pancreaticoduodenal transplantation. Clin. Transplant.1989; 48: 764. Google Scholar 15 : Technique of simultaneous renal pancreaticoduodenal transplantation with urinary drainage of pancreatic secretion. Amer. J. Surg.1987; 153: 405. Google Scholar 16 : Biopsy-directed immunosuppression following hepatic transplantation in man. Transplantation1985; 39: 589. Google Scholar 17 : Experience with simultaneous pancreas-kidney transplantation. Ann. Surg.1988; 208: 475. Google Scholar 18 : A three-year experience with serum anodal trypsinogen as a biochemical marker for rejection in pancreatic allografts. False positives, tissue biopsy, comparison with other markers and diagnostic strategies. Transplantation1992; 53: 415. Google Scholar 19 : Characterization of immunoreactive trypsin as a means of differentiating graft pancreatitis and allograft rejection after porcine pancreatic transplantation. Transplantation1992; 53: 25. Google Scholar 20 : 111-Indium platelets in monitoring pancreatic allografts in man. Brit. J. Surg.1985; 72: 228. Google Scholar 21 : Evidence that the soluble interleukin 2 receptor level may determine the optimal time for cystoscopically-directed biopsy in pancreaticoduodenal allograft recipients. Transplantation1990; 49: 363. Google Scholar 22 : Role of duodenal biopsy in bladder-drained pancreas transplants. Transplant. Proc.1992; 24: 1247. Google Scholar 23 : Exocrine dysfunction evaluation of bladder-drained pancreaticoduodenal transplants using a transcystoscopic biopsy technique. Transplant. Proc.1992; 24: 901. Google Scholar 24 : Rejection patterns after simultaneous pancreaticoduodenal-kidney transplants in pigs. Transplantation1994; 57: 756. Google Scholar 25 : Percutaneous biopsy of bladder-drained pancreas transplants. Transplantation1991; 51: 1213. Google Scholar 26 : Percutaneous biopsy of pancreas transplantation. Transplantation1992; 54: 548. Google Scholar From the Departments of Surgery (Division of Transplantation), Medicine and Pathology, University of Washington, Seattle, WashingtonRequests for reprints: Department of Surgery and Urology, Division of Transplantation, University of Washington, Seattle, Washington 98195© 1995 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byLIN D, KUHR C and MARSH C (2018) ENDOSCOPIC TREATMENT OF BLADDER OUTLET OBSTRUCTION IN MEN AFTER PANCREAS TRANSPLANTATIONJournal of Urology, VOL. 162, NO. 2, (335-338), Online publication date: 1-Aug-1999.Hickey D, Bakthavatsalam R, Bannon C, O'Malley K, Corr J and Little D (2018) Urological Complications of Pancreatic TransplantationJournal of Urology, VOL. 157, NO. 6, (2042-2048), Online publication date: 1-Jun-1997. Volume 153Issue 2February 1995Page: 316-321 Advertisement Copyright & Permissions© 1995 by American Urological Association, Inc.Metrics Author Information Christian S. Kuhr More articles by this author Connie L. Davis More articles by this author Darlene Barr More articles by this author John P. McVicar More articles by this author James D. Perkins More articles by this author Carlos E. Bachi More articles by this author Charles E. Alpers More articles by this author Christopher L. Marsh More articles by this author Expand All Advertisement PDF downloadLoading ...