Vascular Complications of Allograft Nephrectomy

Eng, Molly; Power, Richard E.; Hickey, David P.; Little, Dilly

doi:10.1016/j.ejvs.2006.01.008

Cited by 38 publications

(48 citation statements)

References 10 publications

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“…The rate of AN in patients with GF varies widely from 0.5-43 % according to individual center policies [6][7][8][9][10][11][12][13][14][15]. However, the vast majority of ANs are performed within the first year of transplant failure and the rate is much higher when GF occurs in the first year following KT [7].…”

Section: Discussionmentioning

confidence: 99%

“…In other instances, AN may be performed for malignancy, as treatment for diseases such as polyomavirus nephropathy, or for space considerations in planning of a subsequent KT. Previous reports suggest that AN may not be appropriate for some patients because of the associated surgical risks including a peri-operative transfusion rate of nearly 50 %, a major surgical complication rate of 15 %, and a mortality rate of 5 % in recent studies [7][8][9][10][11][12][13][14][15]25]. In addition, removal of the graft may lead to greater immunoreactivity and increased panel reactive antibody (PRA) levels, suggesting a potential immunological benefit of leaving the failed graft in place [7,[25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, the technique of subcapsular dissection was developed to improve the safety of the procedure [13]. Historically, AN was associated with a morbidity ranging from 4.3 to 82.1 % and a mortality of 5-16 % [6][7][8][9][10][11][12][13][14][15].…”

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confidence: 99%

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

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…Transplant nephrectomy (TN) for a failed graft has been reported ranging from 5 to 35% in kidney transplant recipients, and is more likely to be performed (up to 56%) in patients who experienced graft failure within 12 months after transplantation [1,2,3,4,5]. The procedure carries significant morbidity such as blood loss, wound infections, and surgical complications, which were reported up to 15%, especially late in the course [6].…”

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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“…In fact, the rate of significant vascular injuries in one AN series was 5.6%. 10 Accordingly, there were 3 intraoperative vascular injuries in our ECAN group (6.8%) versus none in our ICAN group.…”

Section: Discussionmentioning

confidence: 99%

Extracapsular versus intracapsular allograft nephrectomy: impact on allosensitization and surgical outcomes

Touma

Şener

Caumartin

et al. 2013

CUAJ

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Introduction: Our objective was to compare the impact of extracapsular (ECAN) versus intracapsular allograft nephrectomy (ICAN) on allosensitization and surgical outcomes. Methods: Between 1990 and 2004, 96 allograft nephrectomies were performed at our institution. Of these, 29 procedures were performed within 1 month of the transplant and were therefore omitted from analysis. Overall, the results of 44 ECAN and 23 ICAN were reviewed. Results: The mean operative times were 110.9 versus 130.4 min for ICAN versus ECAN (p = 0.02) and the estimated blood loss was 226 mL for ICAN versus 483 mL for ECAN (p = 0.004). Intraoperative and postoperative complications were low using either technique and differences were not statistically significant. Overall, the preoperative to postoperative change in the percentage of panel reactive antibody was +2.1% for ICAN versus +1.2% for ECAN (NS) at 3 to 12 months postoperatively, respectively (NS). The percentage of patients relisted was 33.3% versus 54.3% (NS), and the percentage of patients re-transplanted once relisted was also very similar: 63.2% for ECAN versus 66.7% for ICAN (NS), after a mean follow-up of 4.5 and 8.4 years, respectively. Conclusions: ICAN can be performed with shorter operative times and less blood loss versus the extracapsular approach. As well, this operative approach does not appear to affect allosensitization and the ability to re-transplant patients.

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Vascular Complications of Allograft Nephrectomy

Cited by 38 publications

References 10 publications

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

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

Transplant Nephrectomy: Histologic Findings - A Single Center Study

Extracapsular versus intracapsular allograft nephrectomy: impact on allosensitization and surgical outcomes

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