USE OF ULTRASOUND AND CYSTOSCOPICALLY GUIDED PANCREATIC ALLOGRAFT BIOPSIES AND TRANSABDOMINAL RENAL-ALLOGRAFT BIOPSIES - SAFETY AND EFFICACY IN KIDNEY-PANCREAS TRANSPLANT RECIPIENTS

The use of allograft biopsies to guide treatment after solid organ tra nsplantation is a valuable tool in the detection and treatment of reje ction. Prior development and use of the cystoscopically guided pancrea tic allograft biopsy have allowed for more accurate and timely diagnos is 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, examin ing efficacy and complication rates of pancreas and kidney biopsies in 31 cadaveric pancreas or combined kidney and pancreas transplants per formed between June 1990 and February 1992 with at least 1 year of fol lowup. There were 94 pancreas, 54 kidney and 53 duodenal mucosal biops ies in 29 evaluable patients. This biopsy technique uses a 24.5F side- viewing nephroscope to view the cystoduodenostomy, with the duodenum a cting as a portal for biopsy needles into the pancreas. Pancreatic tis sue is obtained with either an 18 gauge, 500 mm. Menghini aspiration/c ore needle or an 18 gauge, 500 mm. Roth core needle. Percutaneous rena l allograft biopsies are performed independently or simultaneously wit h the pancreas biopsies using a 16 gauge spring loaded needle. Pancrea s biopsies were prompted by clinical indications of rejection (decreas ed urinary amylase, increased serum amylase or increased serum creatin ine) or by protocol (10, 21 and 40 days postoperatively). Among the bi opsies 30% were required by protocol, of which 10 (36%) revealed abnor mal pathological findings and 5 (18%) showed evidence of occult cellul ar rejection. Renal biopsies demonstrated rejection in 69% of the case s. Of simultaneous pancreas/kidney biopsies 33% revealed concomitant r ejection. A total of 88 Menghini needles with 170 passes was used in 7 3 biopsy attempts, yielding 126 tissue cores with a 16% complication r ate. A total of 41 Roth needles was used with 73 passes in 34 biopsy a ttempts, yielding 55 tissue cores with a complication rate of 21%. Com plications 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 i ncluded 1 arteriovenous fistula (2%). We conclude that ultrasound and cystoscopically guided pancreatic allograft biopsy and percutaneous re nal allograft biopsies are safe and essential methods of obtaining tis sue 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 tis sue, although they require different performance techniques. In some c ases both needles are necessary and are complementary in obtaining ade quate tissue. Duodenal biopsies can correlate with pancreatic rejectio n but are preferable only when pancreatic tissue cannot be obtained. P rotocol biopsies are useful in managing kidney and pancreas allografts with surveillance by histological investigation for evidence of allog raft rejection or nephrotoxicity. Urologists who treat pancreas transp lant patients should be aware of the cystoscopically guided pancreatic allograft biopsy technique.