What Is Renal Allograft Protocol Biopsy?
A renal biopsy diagnoses the cause of renal allograft dysfunction. Renal allograft protocol biopsy is done at specific intervals after the transplantation. The indications for renal allograft biopsies are when an abnormal parameter is seen in the biochemical test or changes in the patient's clinical condition.
What Is Allograft?
Allograft is the transplantation of an organ, tissue, or cell from one individual to another of the same species but not identical twins. Allograft taken from another individual and transplanted in another takes longer to incorporate into the recipient's body. There is no second surgical site in the recipient's body as it is taken from another individual. The hospital stay and surgical time are shorter in the case of allograft tissue. The rejection rate of allograft tissue is lesser than organ transplants, and medication is not needed to suppress the body's immunity.
What Is Autograft?
It is called autograft when the tissue is taken from the patient's body and is used for surgical reconstruction procedures. Using autograft tissue is the safest and fastest healing procedure. But for taking the autograft tissue, there can be a second surgical wound site which takes time to recover. This healing time can extend the patient's stay in the hospital, which the patient must recover. Apart from that, a second surgical site can be uncomfortable for the patient even after years following the surgery.
Why Is Renal Allograft Protocol Biopsy Done?
The biopsy of the kidneys is done when there are signs that the kidneys are not working well or when they suspect some undetected problem with the kidney, like infections. Kidneys are prone to infections and other conditions after the transplant, so the recipient must be careful not to contract any infections and follow the doctor's instructions carefully.
So these biopsies will help diagnose and treat these problems after the transplant. The signs of kidney problems are decreased urine output, increased blood pressure, fever, and abnormal values in the urine test, like increased creatinine levels, blood, or protein in the urine. The other signs are damage to the filtering units of the kidney or kidney problems without any clear symptoms. A biopsy can also detect rejection of the transplanted kidney even before any signs, which will help prevent it in the earlier stages.
What Problems Can a Renal Allograft Protocol Biopsy Show?
The renal allograft biopsy will help determine whether the donor's kidney works efficiently. In addition, this biopsy will detect the rejection from both antibodies or the cells. The rejection can happen immediately, slowly, or over a long time.
With time damage to the kidney can occur from the following:
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Decreased blood flow or scarring.
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Viral or bacterial infections.
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Drug-induced injury to the kidney.
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Previous kidney issues that resulted in recurrence of kidney failure.
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Other kidney diseases.
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Tumors in the kidney or tumors from other parts of the kidney affect the kidney.
What Happens During Renal Biopsy?
The tissue samples for biopsy are taken from the kidney. The approach for the samples is usually made from the back, but the transplants are done from the lower abdomen.
The following methods are used for taking the samples during the biopsy:
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Open biopsy - In an open biopsy, an incision is made. The tissue from the kidney is taken, and the incision is closed using stitches. The procedure is done under general anesthesia so the patient will not feel pain. This type of biopsy is only during the time of transplant.
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Percutaneous Biopsy - This is the more common method of biopsy. This procedure is done after giving anesthesia to the skin around the needle's insertion area to take the tissue sample from the kidney. The doctor might use ultrasound to guide the needle's insertion path.
Is There a Reason Why a Transplant Renal Biopsy Might Be Delayed?
There are many reasons for delaying the biopsy procedures. When an infection is suspected before the procedure, the renal biopsy may be delayed till the infection has completely resolved. The other reason for delaying the biopsy is when the patient is on anticoagulants like Warfarin. The anticoagulants need to be stopped several days prior to the surgery. The doctor will assess the risks and the benefits before stopping the anticoagulants.
What to Expect After a Transplant Renal Biopsy?
After the biopsy, the patient will be required to wait for one to two hours to ensure that the patient is well before they leave the hospital. They can drink fluids and pass urine without any problem. After the biopsy, when the patient returns home, they are advised to minimize contact with other people and take enough rest. From the next day onwards, the patient can do their daily activities. But they should avoid heavy lifting activities for two to three days after the biopsy. However, instructions for open surgery biopsy will defer and be given after the procedure.
What Are the Complications of a Transplanted Renal Biopsy?
The risk of the biopsies is minimal, but complications can occur. There are chances for bleeding. The patient can have slightly red-colored urine the day following the procedure. Some patients might have bleeding with clots that require bladder irrigation with a catheter, and if the bleeding is severe, then transfusion might also be required.
But this is a rare complication of biopsy and is seen in less than one percent of the patients. Rarely some patients may have urine infections, especially those who have had a history of frequent infections. Other complications include fever, pain at the biopsy site, and the inability to urinate.
Conclusion
Renal allograft protocol biopsies are essential after the transplant to identify dysfunction in the transplanted kidney. This procedure is done at specified intervals to identify any condition as early as possible. They are done when there is any change in the parameters during the check-up. Transplant patients need to be closely monitored after the transplant for any changes. When any abnormality is noted consult with the concerned doctor for a diagnosis of the condition.
