Nephrectomy Versus Embolization of Non-Functioning Renal Graft: A Systematic Review with a Proportional Meta-Analysis

Abstract

There is no standardization on the timing of the best approach to treat a non-functioning renal graft.We reviewed the literature and performed a proportional meta-analysis of case series of transplantectomy and embolization for a non-functioning renal graft. The groups were compared for mortality and morbidity outcomes.A total of 2421 patients were included in this review. Of these, 2232 patients underwent transplantectomy and 189 underwent percutaneous embolization. The mortality rate in the nephrectomy group was 4% [95% confidence interval [CI], 2–7%; I2=87%] as compared with 0.1% [95% CI, 0.1–0.5%; I2=0%] in the embolization group. The rates of common morbidities were 18% [95% CI, 13–26%, I2=79.7%] for nephrectomy compared with 1.2% [95% CI, 0.7–2.1%, I2=26.4%] for embolization. The incidence of post-embolization syndrome was 68%, and 20% of patients needed post-embolization nephrectomy.Percutaneous embolization was associated with lower mortality and morbidity rates but also with a high rate of post-embolization syndrome. However, in most cases this complication had easily manageable symptoms. Embolization is a new and attractive technique that can be considered in treating non-functioning renal grafts.

The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients

“…Embolization is accomplished by the injection of ethanol followed by stainless steel coils into the branches of the renal artery 43 . Data on the efficacy and safety of this procedure compared with graft nephrectomy are limited, but a recent systematic review and meta‐analysis suggested that renal artery embolization may pose lower risks to patients with a failed allograft 44 . In this review, renal artery embolization successfully treated graft intolerance syndrome in the majority of cases, but 20% required follow‐up nephrectomy.…”

Allograft nephrectomy versus nonallograft nephrectomy after failed renal transplantation: a systematic review by updated meta‐analysis

“…Trans‐vascular embolization demonstrated significantly less postoperative haemorrhages and infections compared with open allograft nephrectomy. Furthermore, the all‐cause mortality was 0.1% in the embolization cohort with 9 case series including 189 patients compared to 4% in conventional transplantectomy cohort in 17 case series including 2175 patients [42].…”

Graft Intolerance Syndrome in Children Treated with Kidney Embolization: A Case Report

“…A common indication for the elimination of the effects of the graft is the control of graft intolerance syndrome through embolization and restart immunosuppression treatment, as was the case in our patient. The most frequent complication after this procedure is post-embolization syndrome, with an incidence of 68%, characterized by fever lasting 2 to 5 days in 59% of cases, local pain, hematuria, nausea and vomiting, which, if persisting, requires the presence of vascularization of the graft and the persistence of immune intolerance to be ruled out [6].…”