Bleeding prevention with desmopressin for allograft kidney biopsies: a double-blind randomized study.

Background: Percutaneous kidney allograft biopsy is essential for evaluating graft dysfunction, but post-procedural bleeding remains the most frequent complication, particularly among recipients with impaired renal function. Desmopressin (DDAVP) is often used prophylactically to reduce bleeding risk, yet its efficacy in the transplant setting remains uncertain. Methods: We conducted a single-center, double-blind, randomized, placebo-controlled trial at a quaternary transplant center in Brazil. Adult kidney transplant recipients with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² undergoing allograft biopsy were randomized (1:1) to receive intravenous desmopressin (0.3 μg/kg) or placebo before biopsy. All procedures were ultrasound-guided and performed by experienced nephrologists. The primary endpoint was any biopsy-related bleeding complication. Secondary outcomes included major bleeding (transfusion, embolization, nephrectomy, or death), minor bleeding (macroscopic hematuria, hematoma, hemoglobin drop >20%), and hyponatremia. Results: A total of 96 biopsies were randomized (48 per group). Baseline demographics, clinical, and procedural characteristics were well balanced. Any biopsy-related bleeding complication occurred in 29.1% of procedures overall, without a significant difference between the desmopressin and placebo groups (35.4% vs. 22.9%, Conclusions: In this trial of high-risk kidney transplant recipients, prophylactic desmopressin did not reduce biopsy-related bleeding complications compared with placebo. Routine pre-biopsy administration is not supported when biopsies are performed under optimal technical conditions and patient preparation.