Intolerance Syndrome in Failed Renal Allografts: Incidence and Efficacy of Percutaneous Embolization

Delgado, Patricia; Díaz, Francisco González; González, Ángel Poncela; Sánchez, Emilio; Gutiérrez, Pedro; Hernández, Domingo; Torres, Armando; Lorenzo, V.

doi:10.1053/j.ajkd.2005.04.024

Cited by 51 publications

(58 citation statements)

References 19 publications

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“…These antibodies could theoretically prevent the highly sensitized patients from receiving another kidney transplant in a timely manner. Although most patients appear clinically asymptomatic after they return to dialysis, a failed graft left in place might induce a chronic inflammatory state with elevated markers of inflammation such as ferritin, C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor-α (TNF-α), as well as decreased albumin, associated with failure to thrive, low-grade fever, erythropoietin resistance, and malnutrition, causing increased morbidity and mortality [10,11,12]. Although finding inflammation in the failed graft might be expected, there is a paucity of data on the histologic examination of nephrectomy specimens in regards to ongoing inflammation and the extent of lesions.…”

Section: Introductionmentioning

confidence: 99%

Transplant Nephrectomy: Histologic Findings - A Single Center Study

Goral

Brukamp²,

Ticehurst³

et al. 2014

Am J Nephrol

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Aims: To identify the histopathological features of transplant nephrectomy (TN) specimens. Methods: We performed retrospective analysis of 73 nephrectomies to review the histopathology in detail and correlate the Banff grading characteristics of TN specimens with time post engraftment and clinical features. Retrospective data on donor-specific antibodies (DSA) were also collected. Results: The majority of patients who had TN in less than 3 months posttransplant (n = 20; median time to TN: 4 days) had hemorrhagic infarction; 7patients (35%) had grade 3 acute rejection (AR). Patients who had TN later than 3 months posttransplant (n = 53; median time to TN: 67 months) had AR, grade 2B (21%) and 3 (43%), coexisting with advanced vascular injury in the form of interstitial hemorrhage, extensive interstitial fibrosis and tubular atrophy (IF/TA) as well as the presence of DSAs. Overall, the majority of patients without DSA pre-TN developed DSA post-TN. Conclusions: Our data revealed extensive inflammation and ongoing immunologic activity in a subset of patients with a failed graft. Careful and individualized approach based on clinical and laboratory data should guide the decision for transplant nephrectomy. i 2014 S. Karger AG, Basel

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Section: Introductionmentioning

confidence: 99%

Transplant Nephrectomy: Histologic Findings - A Single Center Study

Goral

Brukamp²,

Ticehurst³

et al. 2014

Am J Nephrol

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“…Достоинс-твом такого метода, безусловно, является мини-ин-вазивность, короткий реабилитационный период, отсутствие потребности в гемотрансфузиях. Однако в 10-30% случаев, особенно на поздних сроках после трансплантации, эмболизация малоэффективна, ве-роятно, из-за сформировавшихся коллатералей [41]. К возможным осложнениям процедуры относят аб-сцедирование трансплантата, дислокацию эмболи-зирующего агента дистальнее по руслу кровотока, формирование гематомы в области пункции, а так-же лихорадку, боль и гематурию [41,42].…”

Section: удаление нефункционирующего трансплантатаunclassified

“…Однако в 10-30% случаев, особенно на поздних сроках после трансплантации, эмболизация малоэффективна, ве-роятно, из-за сформировавшихся коллатералей [41]. К возможным осложнениям процедуры относят аб-сцедирование трансплантата, дислокацию эмболи-зирующего агента дистальнее по руслу кровотока, формирование гематомы в области пункции, а так-же лихорадку, боль и гематурию [41,42]. Опреде-ленный интерес представляет выполнение эмболи-зации с целью редукции кровотока непосредственно перед хирургическим удалением трансплантата.…”

Section: удаление нефункционирующего трансплантатаunclassified

Repeat Kidney Transplantation

Сушков

2017

RJTAO

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ФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация В настоящее время для большинства пациентов с терминальной почечной недостаточностью пересад-ка почки является наилучшим методом заместительной почечной терапии (ЗПТ), который значительно увеличивает продолжительность и качество жизни. Прогресс в области органного донорства, хирурги-ческой техники, трансплантационной иммунологии и иммуносупрессии существенно улучшил непос-редственные результаты трансплантаций. При этом отдаленная выживаемость трансплантатов в течение последних двух десятилетий практически не изменилась. Несоответствие между показателями отдален-ной выживаемости реципиентов и трансплантатов привело к увеличению количества пациентов, утра-тивших функцию пересаженной почки. Для большинства из них повторная трансплантация представля-ется оптимальным вариантом продолжения ЗПТ, хотя и сопряжена c большей частотой осложнений. При этом рекомендации по проведению ретрансплантации почки, основанные на принципах доказательной медицины, до сих пор отсутствуют. Настоящий обзор основан на материале 100 научных публикаций, посвященных различным аспектам планирования и выполнения ретрансплантации почки. Nowadays, kidney transplantation is the best approach of renal replacement therapy for the majority of patients with end-stage renal disease that signifi cantly improves the quality and length of life. Advances in the fi eld of organ donation, immunosuppression, transplant surgery and immunology have improved short-term graft and patient survival. But the long-term graft survival remains static over last two decades. The disparity between low graft and high patient long-term survival led to increasing number of transplant recipients with failed grafts. Repeat renal transplant is presumed to be a good option for many patients losing their grafts, but it is associated with higher complication rates. Unfortunately, there are no evidence-based recommendations or guidelines for renal retransplantation procedure. This review is based on 100 scientifi c publications related to various aspects of the kidney retransplantation and provides the recent data on this matter. Key words: kidney transplantation, kidney retransplantation, graft failure, graft rejection, immunosuppression.Для корреспонденции: Сушков Александр Игоревич. Адрес: 123182, Москва, ул. Щукинская, д. ВВЕДЕНИЕВ течение последних десятилетий транспланта-ция почки остается оптимальным методом замес-тительной почечной терапии, обеспечивающим по сравнению с лечением диализом лучшую продол-жительность и качество жизни пациентов. По дан-ным актуального регистра ERA-EDTA, пятилетняя выживаемость пациентов при лечении гемо-или перитонеальным диализом составляет 40,6%, а пос-ле пересадки почки от живого или трупного доно-ра -94,3 и 87,1% соответственно [1]. Несмотря на столь впечатляющие результаты, следует признать, что функционирование трансплантата в течение 20 и более лет -ситуация скорее уникальная, чем обычная...

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“…Renal artery embolization is a minimally invasive procedure which is being increasingly used for the treatment of a wide range of conditions (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13). The indications for renal artery embolization overlap with those for surgical nephrectomy, although the less invasive nature of the former is a major advantage.…”

Section: Introductionmentioning

confidence: 99%

“…Transarterial nephrectomy, i.e., complete renal artery embolization, has the potential to be used as an alternative to surgical nephrectomy with an expectation of complete infarction and non-function of the embolized kidney (2, 3, 4, 5, 6, 7, 8). There have been studies demonstrating transarterial nephrectomy as an alternative to surgery for patients with renal graft intolerance, end-stage kidneys associated with severe hypertension or proteinuria or non-functioning hydronephrotic kidneys (2, 3, 4, 5).…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Transarterial Nephrectomy as an Alternative to Surgical Nephrectomy

et al. 2014

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ObjectiveTo evaluate the safety and efficacy of transarterial nephrectomy, i.e., complete renal artery embolization, as an alternative to surgical nephrectomy.Materials and MethodsThis retrospective study included 11 patients who underwent transarterial nephrectomy due to a high risk of surgical nephrectomy or their refusal to undergo surgery during the period from April 2002 to February 2013. Medical records and radiographic images were reviewed retrospectively to collect information regarding underlying etiologies, clinical presentations and embolization outcomes.ResultsThe underlying etiologies for transarterial nephrectomy included recurrent hematuria (chronic transplant rejection [n = 3], arteriovenous malformation or fistula [n = 3], angiomyolipoma [n = 1], or end-stage renal disease [n = 1]), inoperable renal or ureteral injury (n = 2), and ectopic kidney with urinary incontinence (n = 1). The technical success rate was 100%, while clinical success was achieved in eight patients (72.7%). Subsequent surgical nephrectomy was required for three patients due to an incomplete nephrectomy effect (n = 2) or necrotic pyelonephritis (n = 1). Procedure-related complications were post-infarction syndrome in one patient and necrotic pyelonephritis in another patient. Of four patients with follow-up CT, four showed renal atrophy and two showed partial renal enhancement. No patient developed a procedure-related hypertension.ConclusionTransarterial nephrectomy may be a safe and effective alternative to surgical nephrectomy in patients with high operative risks.

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Intolerance Syndrome in Failed Renal Allografts: Incidence and Efficacy of Percutaneous Embolization

Cited by 51 publications

References 19 publications

Transplant Nephrectomy: Histologic Findings - A Single Center Study

Transplant Nephrectomy: Histologic Findings - A Single Center Study

Repeat Kidney Transplantation

Safety and Efficacy of Transarterial Nephrectomy as an Alternative to Surgical Nephrectomy

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