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Role of allograft nephrectomy following kidney graft failure: preliminary experience with pre-operative angiographic kidney embolization

Journal of Nephrology Aims and scope Submit manuscript

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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Correspondence to Robert J. Stratta.

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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

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