Improving Outcomes after Allograft Nephrectomy through Use of Preoperative Angiographic Kidney Embolization

Jacobs, Marie L.; Stratta, Robert J.; Miller, Michael J.; Durrani, R.; Harriman, David; Kiger, David F.; Farney, Alan C.; Rogers, Jeffrey; Orlando, Giuseppe; Jay, Colleen L.

doi:10.1097/xcs.0000000000000079

Cited by 2 publications

(1 citation statement)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Embolization pre-AN was associated with significantly reduced blood loss and transfusion requirements, lower mean operating time, length of hospital stay, and surgical complication rate. 34 Currently, there are no prospective trials to provide data on the benefit of percutaneous renal artery embolization before AN. Embolization largely relies on interventional radiology availability, and the decision to pursue this hybrid approach is dictated by the level of urgency of AN.…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

The Role of Allograft Nephrectomy in the Failing Kidney Transplant

et al. 2023

View full text Add to dashboard Cite

Patients with failed renal allografts have associated increased morbidity and mortality. The individualization of immunosuppression taper is the key element in managing these patients to avoid graft intolerance and sensitization while balancing the risk of continued immunosuppression. Most patients with uncomplicated chronic allograft failure do not require allograft nephrectomy (AN), and there is no clear evidence that it improves outcomes. The AN procedure is associated with variable morbidity and mortality. It is reserved mainly for early technical graft failure or in symptomatic cases associated with allograft infection, malignancy, or graft intolerance syndrome. It may also be considered in those who cannot tolerate immunosuppression and are at high risk for graft intolerance. AN has been associated with an increased risk of sensitization due to inflammatory response from surgery, immunosuppression withdrawal with allograft failure, and retained endovascular tissue. Although it is presumed that for-cause AN after transplant failure is associated with sensitization, it remains unclear whether elective AN in patients who remain on immunotherapy may prevent sensitization. The current practice of immunosuppression taper has not been shown to prevent sensitization or increase infection risk, but current literature is limited by selection bias and the absence of medication adherence data. We discuss the management of failed allografts based on retransplant candidacy, wait times, risk of graft intolerance syndrome, and immunosuppression side effects. Many unanswered questions remain, and future prospective randomized trials are needed to help guide evidence-based management.

show abstract

Section: Morbidity and Mortalitymentioning

confidence: 99%