Objective To analyse the circumstances, results and complications of percutaneous embolization in failed renal grafts that are not tolerated, to avoid surgical graft removal in selected patients. Patients and methods The study included 33 patients (mean age 42 years, SD 13.9) whose renal grafts failed between 1990 and 1999. The patients underwent percutaneous embolization of their renal transplant for graft intolerance syndrome. The allograft was left in situ after failure for a mean (SD) of 9.9 (6.5) months. The subsequent hospital stay, the appearance of complications and the ®nal results were assessed. Results Post-embolization syndrome (fever for 2±5 days) appeared in 20 (61%) of the patients; the clinical intolerance resolved in 28 (85%). The embolization was unsuccessful in ®ve of the 33 patients (15%) and they required graft removal. The mean (SD) hospital stay was 5 (2) days; there were no major complications from graft embolization. Conclusions Graft embolization avoids kidney removal in many patients with failed and rejected transplants, with low rates of morbidity. Surgical graft nephrectomy was useful when graft intolerance syndrome persisted after embolization.
We report 5 cases of renal allograft rupture in which diagnosis was established early through clinical data, laboratory tests and echography. Immediate surgery confirmed the suspicion in all cases. Acute rejection was present in 4 patients and in 1 the previous surgical puncture from the perirenal collection demonstrated serohematic fluid with a biological character similar to that of lymph. This latter case seemed to confirm the suspicion that any process associated with edema in a kidney with obstructed lymphatic tracts (meticulous lymphatic ligatures during donor extraction) is capable of causing a rupture. Conventional surgical treatment is dangerous and insecure on an edematous and friable kidney, resulting in a nephrectomy rate of 55.7 per cent and a postoperative death rate of 8 per cent. Hematoma evacuation, hemostasis by local compression and tridimensional containment of the ruptured areas should be the principles of this operation. By means of renal corsetage with lyophilized human dura these principles can be achieved. This surgical technique, which is simple and secure, its variations and future possibilities are described. In 3 of our 5 patients corsetage with lyophilized human dura was applied. All 5 grafts have taken. Renal function is good in 3 cases and acceptable in 2 at followup between 2 and 15 months.
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