Added Benefit and Risk of an Additional Biopsy or Targeting With Contrast-Enhanced Ultrasound for Patients With Renal Transplants

J. Scott Kriegshauser, Nirvikar Dahiya, Maxwell L. Smith, Nan Zhang, Raymond L. Heilman, Melissa L. Stanton, Scott W. Young, Maitray D. Patel

Research output: Contribution to journalArticlepeer-review


Objectives: To determine whether renal transplant diagnoses substantially change when 2 biopsy sites are chosen and whether contrast-enhanced ultrasound (CEUS) has value for targeting the second site. Methods: We prospectively enrolled 40 patients undergoing ultrasound-guided renal transplant biopsy within 2 years of transplant: 20, surveillance; and 20, for cause. A CEUS examination was performed to identify cortical regions with subjectively altered flow. One biopsy was performed at the operator-preferred (primary) site regardless of CEUS findings. Another biopsy was done at a second location, either targeted to an area in which CEUS perfusion findings differed from the primary site (targeted) or at a random location (secondary) if no other area differed. Specimens were randomly labeled A or B; pathologists were blinded to the CEUS result and biopsy location. Location-specific CEUS assessments were recorded. Pathologic results were compared, including acute and chronic Banff scores and any new findings from the targeted or secondary biopsy. Results: Forty patients were enrolled between January 2016 and December 2018. No location-specific pathologic differences correlated with differences in CEUS assessments. The second biopsy provided additional information that changed management in 4 of 40 patients (10.0% [95% confidence interval, 2.8%–23.7%]). Major bleeding complications occurred in 3 of 40 (7.5%) patients. Conclusions: Contrast-enhanced ultrasound targeting was not useful. Major bleeding complications were higher than expected, possibly due to the additional biopsy away from the operator-preferred location. Obtaining a second renal transplant biopsy from a substantially different area than the initial operator-preferred location provided additional clinically useful information in 10% of patients.

Original languageEnglish (US)
Pages (from-to)1603-1611
Number of pages9
JournalJournal of Ultrasound in Medicine
Issue number8
StatePublished - Aug 2021


  • contrast agents
  • image-guided biopsy
  • perioperative complications
  • transplants
  • ultrasound imaging

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging


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