Allograft Nephrectomy: A Single-Institution, 10-Year Experience

Freitas, Rui; Malheiro, Jorge; Santos, Clara; Costa, Rui Miguel; Martins, La Salete; Almeida, Manuela; Dias, Leonídio; Castro-Henriques, António; Cabrita, António; Silva-Ramos, Miguel; Almeida, Rui

doi:10.1016/j.transproceed.2015.03.028

Cited by 10 publications

(21 citation statements)

References 16 publications

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“…These studies were heterogeneous with varying policies regarding the removal of failed grafts. In a large USRDS cohort (1995–2003), nephrectomy was performed in 27% of 15 400 patients with late graft failure (graft survival >1 year) . In our cohort, most graft nephrectomies were performed shortly after graft failure (88% within 1 year), which is in agreement with findings in other studies .…”

Section: Discussionsupporting

confidence: 90%

Graft intolerance syndrome requiring graft nephrectomy after late kidney graft failure: can it be predicted? A retrospective cohort study

et al. 2017

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Graft nephrectomy is recommended in case of early graft failure. When the graft fails more than 3-6 months after transplantation, it is current practice to follow a wait-and-see policy. A common indication for graft removal is the graft intolerance syndrome. We aimed to create a risk prediction model for the occurrence of graft intolerance resulting in graft nephrectomy. We collected data of kidney transplantations performed in our center between 1980 and 2010 that failed at least 6 months after transplantation. We evaluated the association between baseline characteristics and the occurrence of graft nephrectomy because of graft intolerance using a competing risk regression model. Prognostic factors were included in a multivariate prediction model. In- and exclusion criteria were met in 288 cases. In 48 patients, the graft was removed because of graft intolerance. Donor age, the number of rejections, and shorter graft survival were predictive factors for graft nephrectomy because of the graft intolerance syndrome. These factors were included in a prediction rule. Using donor age, graft survival, and the number of rejections, clinicians can predict the need for graft nephrectomy with a reasonable accuracy.

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Section: Discussionsupporting

confidence: 90%

Graft intolerance syndrome requiring graft nephrectomy after late kidney graft failure: can it be predicted? A retrospective cohort study

et al. 2017

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“…The only difference observed between the outcomes after the two techniques was mean hospital length of stay, which was 13.8 days in the EC group and 7.6 days in the IC group ( p = 0.01). Smaller studies comparing the IC and EC techniques have not shown a clear association between technique and blood loss [ 35 – 37 ].…”

Section: Outcomes After Gnmentioning

confidence: 99%

“…Studies that did not take into account the timing of GN showed that GN was associated with an increase in detectable HLA-Ab and new DSA [ 46 – 50 ]. Analyses comparing IC and EC GN on allosensitisation were unable to detect a difference in PRA score between the two techniques [ 35 , 37 ].…”

Section: Outcomes After Gnmentioning

confidence: 99%

Graft nephrectomy in children

Phillips

Callaghan

2017

Pediatr Nephrol

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Kidney transplantation is recognised as the gold standard treatment of end-stage renal disease in most children, with excellent graft survival rates. When graft failure occurs, renal transplant recipients (RTRs) have the option of removal of the transplant (graft nephrectomy [GN]), or leaving the failed transplant in situ. The aims of this review are to discuss the indications for GN, surgical techniques, outcomes after GN (including risks of allosensitisation and the impact on subsequent transplants), and the possible role of routine GN in the asymptomatic RTR with a failed renal allograft. Literature in both the pediatric and adult renal transplant fields is reviewed. We also discuss how future research in this area could advance our knowledge of which patients to select for GN, and the most appropriate surgical approach.

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“…A korai és késői csoport össze-hasonlításakor az indikációs kört más kutatásokkal egyetértésben [2,10,18] alapvetően eltérőnek találtuk. A korai nephrectomiák leggyakrabban artériás keringési zavar miatt történtek, amit egyenlő arányban követett a vénás és kombinált keringési zavar, valamint hiperakut és akut rejectio.…”

Section: áBra Graftectomizált éS Nem Graftectomizált Betegek Túléléséunclassified

“…Bár a korai graftectomiák esetében a posztoperatív szövődmények és mortalitás valamivel magasabb arányát észleltük, mint a késői csoportban, a különbség nem volt szignifikáns, ellentétben Sun és mtsai [10], illetve Freitas és mtsai [18] közléseivel. Viszont más szerzők (Mazzucchi és mtsai) inkább a késői graftectomiák után szá-moltak be magasabb szövődményarányról, amelyet a ké-sői műtétek technikailag nehezebb voltával magyaráztak [6].…”

Section: áBra Graftectomizált éS Nem Graftectomizált Betegek Túléléséunclassified

Graftectomiák a debreceni vesetranszplantációs programban

et al. 2016

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Bevezetés: A graftectomia indikációja és pontos időzítése bizonyos esetekben vita tárgya, elsősorban a tüneteket nem okozó, már nem működő graftok esetén. Célkitűzés: A szerzők átfogó képet kívántak adni a debreceni veseátültetési programban elvégzett graftectomiákról. Módszer: Retrospektív vizsgálattal elemezték a 2004. január 1. és 2015. december 31. között veseátültetett betegek adatait. Áttekintették a graftectomiák indikációit, időzítését, szövődménye-it, továbbá összehasonlították a korai és késői graftectomiákat. Eredmények: A vizsgált időszakban 480 veseátültetés történt. Közülük 55 betegnél (11%) történt graftectomia. A gyakoribb indikációk a következők voltak: krónikus allograft-nephropathia (47%), artériás keringési zavar (13%), ureterszövődmények (9%). A grafteltávolítás 22 betegnél (40%) akut, 33-nál (60%) tervezett volt. A graftectomiák 24%-a a transzplantáció után 30 napon belüli, 76%-a késői volt. Korai graftectomiát túlnyomórészt artériás keringészavar (31%), a későiek többségét (62%) krónikus allograftnephropathia miatt végezték. Következtetések: A vizsgált időszakban a graftectomiák leggyakoribb oka krónikus allograft-nephropathia volt. Az esetek döntő többségében elektív műtét történt. A szakirodalomban közöltekhez hasonlóan a szerzők a korai és késői graftectomiák jellemzőit eltérőnek találták. Orv. Hetil., 2016, 157(24), 964-970. Kulcsszavak: vesetranszplantáció, graftelégtelenség, veseallograft-túlélés, graftectomia Allograft nephrectomy -a single-center experienceIntroduction: Indication and timing of allograft nephrectomy is still uncertain in some cases. Aim: The aim of the authors was to summarize their experience with graftectomies. Method: Data from patients who underwent kidney transplantation between January 1, 2004 and December 31, 2015 were retrospectively analyzed. Frequency, indications, timing, complications as well as early and late allograft nephrectomies were reviewed. Results: From 480 renal transplants, 55 graftectomies were performed (11%). Frequent indications included chronic allograft nephropathy (47%), arterial blood supply complications (13%), ureter complications (9%). 22 cases (40%) of allograft nephrectomies were urgent while 33 cases (60%) were elective. 24% of graftectomies were performed within 30 days after transplantation and 76% thereafter. Conclusions: The main indications for early graftectomies were arterial complications (31%) and chronic allograft nephropathy (62%) in cases of late graftectomies. The majority of the graftectomies were elective. Leading indication was chronic allograft nephropathy. Early and late graftectomies have different characteristics.

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Allograft Nephrectomy: A Single-Institution, 10-Year Experience

Cited by 10 publications

References 16 publications

Graft intolerance syndrome requiring graft nephrectomy after late kidney graft failure: can it be predicted? A retrospective cohort study

Graft intolerance syndrome requiring graft nephrectomy after late kidney graft failure: can it be predicted? A retrospective cohort study

Graft nephrectomy in children

Graftectomiák a debreceni vesetranszplantációs programban

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