PEDIATRICS

E.C. Ip¹, R.E. Kirby², E. Craig¹, F. Mackie³, S. Kennedy³, A. Rosenberg³, G. Kainer³, J. Frawley², K. Haghighi^2
1Department Of Surgery, Prince of Wales Hospital, Sydney/NSW/AUSTRALIA, ²Department Of Surgery, Prince of Wales Hospital, Sydney/AUSTRALIA, ³Department Of Nephrology, The Sydney Children's Hospital, Sydney/AUSTRALIA

Body: Background: Kidney transplantation is the optimal treatment for end-stage renal disease. In the paediatric population because of small abdominal cavity, kidneys have been transplanted intraperitoneally as orthotopic kidney transplants. Orthotopic kidney transplantation has provided excellent results in terms of patient and graft survival. Purpose: To assess the safety of biopsying orthotopically transplanted kidneys in small children. Methodology: All paediatric orthotopic kidney transplantations in a single centre, the Sydney Children’s Hospital, from 1987 to 2009 were retrospectively identified (n=41). Data on biopsy adequacy and complications were prospectively collected. Biopsies were performed under ultrasound guidance and general anaesthetic by nephrologists, with 18G automated biopsy needle and gun (Biopty/Bard). Results: 25 males (61%) and 16 females (39%) with ages ranging 1 to 17 years (median age 7 years), underwent orthotopic kidney transplantation between 1987 and 2009. 25 (61%) underwent a total of 54 biopsies because of deterioration of renal function (n=48), anuria (n=1), proteinuria (n=1) and for protocol surveillance purposes (n=4). 53 biopsies (98%) achieved adequate specimen for histological purposes (Banff criteria for glomeruli, >7), with only 1 biopsy retrieving an inadequate sample. Following biopsy, 4 cases (7%) of new-onset macroscopic haematuria were observed, although these had resolved by 2 days and did not require subsequent blood transfusion, radiographic or surgical intervention. Other complications such as infection or graft loss did not occur. Conclusions: Paediatric orthotopically transplanted kidneys can be biopsied safely under ultrasound guidance with minimal complications.

Disclosure: All authors have declared no conflicts of interest.