Recurrent graft pain following renal autotransplantation for loin pain haematuria syndrome

Abstract

Objective To review retrospectively the Perth experience of autotransplantation for loin pain haematuria syndrome and identify possible factors associated with its failure. Patients and methods The medical records of 11 women patients (median age 42 years, range 29–48) who had 12 autotransplantations were reviewed. All patients were then interviewed and asked whether they considered the operation a success. Results All patients initally had complete relief of symptoms. Three patients who had four transplants are still symptom‐free with a follow‐up of 24–46 months. Five patients have had partial relief with marked variability in their patterns of recurrent pain. Three patient have symptoms as severe as those before operation. One kidney was lost because of acute thrombosis and another developed a urinoma. No patient had deterioration in renal function. Conclusion Renal autotransplantation is a treatment option of last resort, with acceptable morbidity in patients with intractable, functionally disabling renal pain, but three‐quarters of these patients may develop recurrent pain in the transplant site. A current or past history of depression or absence of haematuria may represent risk factors for a poor post‐operative prognosis. Treatment failure is predictable by a poor response to sympathetic neurolytic block.

Clinical and safety outcomes of laparoscopic nephrectomy with renal autotransplantation for the loin pain‐hematuria syndrome: a 14‐year longitudinal cohort study

“…The findings in this study confirmed the safety of autotransplantation in mortality and renal function described in previous studies (34,37). Although a limitation of follow-up time in renal function and number of autotransplant cases may potentially have underpowered the result in our study, we found no significant changes in eGFR and rate of eGFR declined after autotransplantation.…”

“…Previous studies reported success rate in pain relief of from 25% up to 70% for patients with LPHS undergoing autotransplantation (2,7,19,(22)(23)(24)30). Rates of pain recurrence after autotransplantation were demonstrated as many as 24% to 75% (30)(31)(32)(33)(34)(35)(36). Our study showed a higher rate of pain relief at 87.5% with a pain recurrence rate of 25%.…”

The use of surgical sympathectomy in the treatment of chronic renal pain

“…Neural degeneration and regeneration in human renal allografts ation has also been reported [24,25]. In a series of 12 renal autotransplantations, with a follow-up of 24-56 and isografts was also studied by Gazdar and Dammin [19] who concluded that 19 days after renal transplanmonths, Parnham et al [25] reported complete freedom of pain in only three of 11 patients, a recurrence rate tation most renal axons had degenerated, but that by the 28th day there was demonstrable regeneration of considerably higher than the 10% reported by Chin [24]. The long-term outcome of renal autotransplantation for these nerves and that the number of regenerating axons increased as long as the graft survived.…”

The outcome of renal denervation for managing loin pain haematuria syndrome

“…The early onset of most failures after denervation may be secondary to neuronal regeneration, which has been reported in human renal allograft transplants by 28 days after transplantation [10–12]. However, this is controversial, and the absence of sympathetic re‐innervation has been documented in both humans and rats for at least 9 months after transplanting [13,14].…”