Surgical Complications of Graft Nephrectomy in the Modern Transplant Era

Mazzucchi, Eduardo; Nahas, W. C.; Antonopoulos, Ioannis; Piovesan, Affonso; Ianhez, Luiz Estevam; Arap, Sami

doi:10.1097/01.ju.0000080566.42381.94

Cited by 54 publications

(81 citation statements)

References 11 publications

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“…Estimated blood loss was less than 25 cm 3 . The patient was admitted to the floor and resumed oral intake and mobilization hours following surgery.…”

Section: Resultsmentioning

confidence: 86%

“…Second, the robotic transabdominal approach allowed for control of the vascular inflow to the kidney prior to mobilization of the renal parenchyma, a step often associated with significant bleeding during open TN. In our series of open TN the average intra-operative blood loss was 395 cm 3 and 50% of patients required a peri-operative blood transfusion (Table 1) (unpublished data, M. Mulloy, Atlanta, GA, March 2014). In this case, early control of vascular inflow resulted in minimal blood loss (less than 25 cm 3 ) and there was no need for a peri-operative blood transfusion.…”

Section: Discussionmentioning

confidence: 88%

“…The presence of postsurgical scarring and dense inflammation make dissection and removal of the failed allograft technically demanding. In recent series of TN significant morbidity was reported in 10-40% of patients and was mostly attributed to hemorrhage or infection (1)(2)(3)(4)(5). However, significant injuries to surrounding structures such as the bladder, colon and iliac vessels have been reported as well (1,3,5).…”

Section: Introductionmentioning

confidence: 99%

“…In recent series of TN significant morbidity was reported in 10-40% of patients and was mostly attributed to hemorrhage or infection (1)(2)(3)(4)(5). However, significant injuries to surrounding structures such as the bladder, colon and iliac vessels have been reported as well (1,3,5). The overall mortality rate associated with TN ranged from 3% to 9% and was mostly attributed to septic complications following surgery (1)(2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

“…However, significant injuries to surrounding structures such as the bladder, colon and iliac vessels have been reported as well (1,3,5). The overall mortality rate associated with TN ranged from 3% to 9% and was mostly attributed to septic complications following surgery (1)(2)(3)(4)(5). In summary, TN is an invasive procedure associated with significant potential morbidity and mortality risk as well as considerable patient discomfort.…”

Section: Introductionmentioning

confidence: 99%

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Robotic Trans-Abdominal Transplant Nephrectomy for a Failed Renal Allograft

Mulloy

Tan

Wolf

et al. 2014

American Journal of Transplantation

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Minimally invasive surgery for removal of a failed renal allograft has not previously been reported. Herein, we report the first robotic trans-abdominal transplant nephrectomy (TN). A 34-year-old male with Alport's syndrome lost function of his deceased donor allograft after 12 years and presented with fever, pain over his allograft and hematuria. The operation was performed intra-abdominally using the Da Vinci Robotic Surgical System with four trocars. The total operative time was 235 min and the estimated blood loss was less than 25 cm 3 . There were no peri-operative complications observed and the patient was discharged to home less than 24 h postoperatively. The utilization of robotic technology facilitated the successful performance of a minimally invasive, trans-abdominal TN.

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“…Estimated blood loss was less than 25 cm 3 . The patient was admitted to the floor and resumed oral intake and mobilization hours following surgery.…”

Section: Resultsmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Robotic Trans-Abdominal Transplant Nephrectomy for a Failed Renal Allograft

Mulloy

Tan

Wolf

et al. 2014

American Journal of Transplantation

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Transplant nephrectomy: indication, surgical approach and complications—experiences from a single transplantation center

Mang,

Haag,

Liefeldt

et al. 2024

World J Urol

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Purpose Management of a failed kidney allograft, and the question whether it should be removed is a challenging task for clinicians. The reported risks for transplant nephrectomy (TN) vary, and there is no clear recommendation on indications or surgical approach that should be used. This study gives an overview of indications, compares surgical techniques, and identifies risk factors for higher morbidity. Methods Retrospective analysis was conducted on all transplant nephrectomies performed between 2005 and 2020 at Charité Hospital Berlin, Department of Urology. Patient demographics, laboratory parameters, graft survival data, indication for TN, and surgical complications were extracted from medical reports. Results A total of 195 TN were performed, with graft intolerance syndrome being the most common indication in 52 patients (26.7%), acute rejection in 36 (18.5%), acute infection in 30 (15.4%), and other reasons to stop immunosuppression in 26 patients (13.3%). Rare indications were vascular complications in 16 (8.2%) and malignancies in the allograft in six (3.1%) cases. Extracapsular surgical approach was significantly more often used in cases of vascular complications and earlier allograft removal, but there was no difference in complication rates between extra- and intracapsular approach. Acute infection was identified as an independent risk factor for a complication grade IIIb or higher according to Clavien–Dindo classification, with a HR of 12.3 (CI 2.2–67.7; p = 0.004). Conclusion Transplant nephrectomy should only be performed when there is a good indication, and non-elective surgery should be avoided, when possible, as it increases morbidity.

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