*Purpose: Pre-LT kidney biopsy is seldom performed in LT candidates with renal dysfunction and/or proteinuria partially due to the limited information regarding KBx bleeding. We aimed at identifying the incidence and predictors of bleeding after KBx in LT candidates.

*Methods: We retrospectively examined variables associated with post-KBx bleeding in 128 LT candidates who underwent pre-LT KBx for kidney dysfunction, proteinuria and/or hematuria. Post-KBx bleeding was defined as the need for ≥2 units of packed red blood cells transfusion (PRBCs) or the need for selective embolization. Patients had an initial INR and platelet count checked the morning of the biopsy. Fresh frozen plasma (FFP) and/or platelet transfusion were administered as needed to lower INR to <1.5 and raise platelet count to >50,000.

*Results: Post-KBx bleeding developed in 16 (12%) patients, 5 of whom underwent selective embolization while bleeding spontaneously stopped in 11 patients. Predictors of post-KBx bleeding are presented in Table 1.

*Conclusions: 1) Post-KBx bleeding in LT candidates with renal dysfunction occurred in 12% of patients but only 5 (4%) required selective embolization. 2) Candidates who experienced post-KBx bleeding had higher initial INR and lower initial platelet count and their final INR and platelet count did not significantly change despite requiring higher number of FFP and platelet transfusion prior to the biopsy. 3) Kidney function, duration of dialysis, kidney size, biopsy approach and number of kidney biopsy passes did not impact post-KBx bleeding risk.

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