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

Introduction: Allograft nephrectomy (AN) is not without morbidity following graft failure (GF) in kidney transplantation (KT).
Methods: Single center retrospective review of all adult patients undergoing AN following KT, including a subset of patients who underwent pre-operative angiographic kidney embolization (PAKE).
Results: Over a 104 month period, 853 adult patients underwent deceased donor KT. With a median follow-up of 3.5 years, 174 patients (20.4%) developed GF and 38/174 (21.8%) underwent AN. The rate of AN was higher in patients with delayed graft function [DGF, Odds Ratio (OR) 2.15, p = 0.023] and early GF (OR 1.7, p = 0.064). For patients undergoing PAKE (n = 13, mean timing of AN 27.5 months post-KT), the estimated intra-operative blood loss was reduced from a mean of 375 ± 530 to 100 ± 162 ml (p < 0.10), mean peri-operative transfusion requirements were reduced from 3.36 ± 4.8 to 0.23 ± 0.44 units (p < 0.05), and total mean operating time was reduced from 192 ± 114 to 141 ± 38 min (p = NS) compared to 13 control patients undergoing AN in the absence of vascular thrombosis or PAKE. Mean length of hospital stay was decreased from 8.5 ± 9 to 5.5 ± 3 days (p = NS) in patients with PAKE. Surgical complication and infection rates and hospital charges were comparable.
Conclusions: Delayed graft function and early GF are associated with a higher rate of AN. PAKE may result in less blood loss, fewer transfusions, reduced operating time, and shorter length of stay, which may translate into reductions in morbidity.