Abstract
Introduction
Allograft nephrectomy (AN) is not without morbidity following graft failure (GF) in kidney transplantation (KT).
Methods
Single center retrospective review of all adult patients undergoing AN following KT, including a subset of patients who underwent pre-operative angiographic kidney embolization (PAKE).
Results
Over a 104 month period, 853 adult patients underwent deceased donor KT. With a median follow-up of 3.5 years, 174 patients (20.4 %) developed GF and 38/174 (21.8 %) underwent AN. The rate of AN was higher in patients with delayed graft function [DGF, Odds Ratio (OR) 2.15, p = 0.023] and early GF (OR 1.7, p = 0.064). For patients undergoing PAKE (n = 13, mean timing of AN 27.5 months post-KT), the estimated intra-operative blood loss was reduced from a mean of 375 ± 530 to 100 ± 162 ml (p < 0.10), mean peri-operative transfusion requirements were reduced from 3.36 ± 4.8 to 0.23 ± 0.44 units (p < 0.05), and total mean operating time was reduced from 192 ± 114 to 141 ± 38 min (p = NS) compared to 13 control patients undergoing AN in the absence of vascular thrombosis or PAKE. Mean length of hospital stay was decreased from 8.5 ± 9 to 5.5 ± 3 days (p = NS) in patients with PAKE. Surgical complication and infection rates and hospital charges were comparable.
Conclusions
Delayed graft function and early GF are associated with a higher rate of AN. PAKE may result in less blood loss, fewer transfusions, reduced operating time, and shorter length of stay, which may translate into reductions in morbidity.
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Abbreviations
- AN:
-
Allograft nephrectomy
- DCD:
-
Donation after cardiac death
- DGF:
-
Delayed graft function
- DWFG:
-
Death with functioning graft
- EBL:
-
Estimated blood loss
- ECD:
-
Expanded criteria donor
- GF:
-
Graft failure
- KT:
-
Kidney transplantation
- LOS:
-
Length of stay
- OR:
-
Odds ratio
- PAKE:
-
Pre-operative kidney embolization
- PRA:
-
Panel reactive antibody
- SCD:
-
Standard criteria donor
- USRDS:
-
United states renal data system
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Al-Geizawi, S.M., Singh, R.P., Zuckerman, J.M. et al. Role of allograft nephrectomy following kidney graft failure: preliminary experience with pre-operative angiographic kidney embolization. J Nephrol 28, 379–385 (2015). https://doi.org/10.1007/s40620-014-0145-1
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DOI: https://doi.org/10.1007/s40620-014-0145-1