Percutaneous embolization of the failed renal allograft in patients with graft intolerance syndrome

Abstract

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.

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

“…Post-embolization syndrome with fever, pain, and leukocytosis was reported in 23/25 patients, including one patient who had fever for 60 days post embolization. Other studies have reported similar results for embolization as primary therapy for symptomatic or failed renal allografts [17][18][19][20][21]. Consequently, using embolization as an alternative to AN has been associated with both infectious complications, postembolization syndrome and mortality [20].…”

“…The availability of a less invasive treatment for or approach to the symptomatic failed renal allograft that minimizes morbidity and mortality is desirable and could potentially impact indications for AN. Arterial embolization as a definitive alternative to AN has been reported previously [16][17][18][19][20][21]. In 2003, Atar et al [16] described their 7 year experience with embolization used in lieu of AN in 25 patients to treat symptomatic rejection.…”

“…Embolization of the allograft as primary therapy has been suggested as an alternative to nephrectomy but the need for a second embolization due to development of collateral circulation arising from lumbar vessels, recurrence of symptoms of rejection, fever, the potential for infection with possible abscess formation, and pain following embolization are all reasons why embolization is generally not considered as definitive therapy in patients with a symptomatic failed allograft [16][17][18][19][20][21]. However, limited data are available on the use of preoperative angiographic kidney embolization (PAKE) to induce allograft infarction prior to planned nephrectomy [22].…”

Perkutane Totalembolisation der Niere - eine Übersicht

“…Abszedierungen nach Nierenembolisation beschrieben [16]. So berichten Gonzalez et al über 3 von 33 Patienten, bei denen aufgrund einer Abstoßung eine Transplantatniere embolisiert worden war, über Nierenabszedierungen mit Notwendigkeit der chirurgischen Nephrektomie [16].…”

Safety and Efficacy of Transarterial Nephrectomy as an Alternative to Surgical Nephrectomy

“…Renal artery embolization is a minimally invasive procedure which is being increasingly used for the treatment of a wide range of conditions (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13). The indications for renal artery embolization overlap with those for surgical nephrectomy, although the less invasive nature of the former is a major advantage.…”