Urological complications associated with a kidney transplant biopsy: report of 3 cases and review of the literature.

During the last 12 years 400 renal allograft biopsies have been performed at this institution to facilitate the differential diagnosis of post-transplant renal dysfunction. Of these cases significant urological complications occurred in 3. In 1 patient a caliceal cutaneous fistula developed after an open surgical biopsy, which required nephrostomy drainage for 6 months. The other 2 patients had needle biopsies and, subsequently, anuria occurred from ureteral blood clots. The problem resolved spontaneously after 23 hours in 1 patient and after 30 hours in the other. The complications in these 3 patients are believed to have resulted from a deeper biopsy and consequent damage to the medullary vasculature and the pelviocaliceal collecting system. Because of these and other potential problems, renal transplant biopsies should be performed by experienced staff, after careful consideration of the risk/benefit ratio at each individual setting.