Objective To summarize the occurrence of complications in renal graft biopsy, and to analyze the indications for puncture and types of pathological diagnosis.

Methods The data of 703 samples of ultrasound-guided renal graft biopsy from 644 kidney transplant recipients from January 1, 2017, to December 31, 2022 was retrospectively analyzed. The puncture qualification rate, complications, indicative biopsy indications and pathological diagnosis types were analyzed. The application of surveillance biopsy and pathological diagnosis were also analyzed.

Results The qualification rate of renal tissue puncture biopsy was 99.9%, and the complications of puncture bleeding included one sample of perinephric hematoma and one sample of hematuria. Increased serum creatinine (76.8%) and proteinuria (13.8%) were the main indications for puncture, and 48 samples (6.8%) were surveillance biopsy for the assessment of therapeutic effects. A total of 399 samples of pathological diagnosis of rejection, including 293 samples of cellular rejection reaction, 60 samples of antibody rejection reaction, and 46 samples of mixed rejection reaction. One hundred and ninety-five samples of recurrence or new-onset kidney disease, mainly including 144 samples of IgA nephropathy and 42 samples of focal segmental glomerulosclerosis. Fifty-seven samples of infection related kidney disease, including 56 samples of BK virus-associated nephropathy (BKVAN). Thirty-one samples of calcineurin inhibitor (CNI) nephrotoxicity injury, including 15 samples of acute CNI nephrotoxicity injury and 16 samples of chronic CNI nephrotoxicity injury. Forty-five samples for other diagnoses.

Conclusions The success rate and safety of renal graft biopsy are high, and at present, cellular rejection reaction is still the main pathological diagnosis of indicative biopsy for renal graft.