Background: Pancreas allograft biopsy (Bx) is the gold standard in diagnosing allograft rejection. The safety of this procedure has been controversial, thus limiting its widespread use. The largest safety data was published 15 years ago describing the rate of complications with ultrasound (US) guided percutaneous Bx in both enteric and bladder drained pancreas transplants (Tx). Since then, pancreas Tx surgical techniques have evolved, to include mostly enteric rather than bladder drained Tx. We hereby review the safety of US and computed tomography (CT) guided percutaneous pancreas allograft Bx in 119 consecutive Bx of enteric drained pancreas allografts.

Methods: We reviewed 298 cases of enteric pancreas Tx performed at our institution between 2001 and mid 2016. 77 patients (37 simultaneous pancreas kidney, 20 pancreas after kidney, and 20 pancreas Tx alone) underwent one or more percutaneous allograft Bx. Biopsies were performed with an 18-gauge needle, under direct US or CT guidance.

Results: A total of 119 Bx were performed. Thirty Bx were in patients with venous portal drainage (PD) and 89 in patients with systemic drainage (SD). Twenty five Bx were performed under CT guidance and 94 under US guidance. Patients underwent a mean of 2.2 passes (range:1-4) per procedure. 84% of the Bx in the CT group and 86% of the Bx in the US group were adequate (p=0.74). There were a total of 4 Bx related complications (3.36%), all occurring in the US guided group. Those included 2 inadvertent small bowel punctures that were clinically silent and 2 intra abdominal bleeds that were managed conservatively. The small bowel punctures occurred in patients with PD as opposed to the bleeds that occurred in those with SD. No complications occurred in the CT guided group. There were no graft losses and no complications requiring surgical intervention.

Conclusions: Percutaneous pancreas allograft Bx has a low incidence of complications in the most recent era of enteric drained pancreas Tx, and appears to be as safe as renal allograft Bx. The more recent widespread use of CT rather than US guided Bx, seems to be promising in decreasing the incidence of Bx related complications, but larger studies are needed to corroborate this hypothesis. Given the evidence of low risk associated with the procedure, percutaneous transplant biopsies of pancreas allografts should systematically be performed as part of the accurate diagnosis and management of pancreas allograft rejection.

CITATION INFORMATION: Kassis Y, Poggio E, Zaky Z. Safety of Percutaneous Pancreas Allograft Biopsy in Enteric Drained Pancreas Transplants. Am J Transplant. 2017;17 (suppl 3).

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