20 March 2024 : Original article
[In Press] Transplant Nephrectomy: A Comparative Study of Timing and Techniques in a Single Institution
Ursula Pession1ABCDE, Ingrid Lammers1BCF, Ingeborg Hauser2AE, Teresa Schreckenbach1CE, Andreas Schnitzbauer1E, Jeannine Lang2B, Michael Heise1BD, Wolf Otto Bechstein1ADEDOI: 10.12659/AOT.942252
Ann Transplant In Press; DOI: 10.12659/AOT.942252
Available online: 2024-03-20, In Press, Corrected Proof
Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule
Abstract
BACKGROUND
Transplant nephrectomy (TN) has historically been associated with high morbidity and mortality rates. Our objective is to share our own experience and compare indications and surgical outcomes between early and late TN and intracapsular (ICAN) and extracapsular allograft nephrectomy (ECAN) techniques.
MATERIAL AND METHODS
Our study included all 69 TN procedures performed between January 2010 and February 2021. Of these, 17 TN procedures were performed within the first 60 days after transplantation (referred to as ‘early’), while the remaining 52 procedures were performed later (‘late’). Within the late allograft nephrectomy (AN) group, we compared the outcomes of intracapsular (ICAN) and extracapsular (ECAN) techniques. We conducted a statistical analysis using the chi-square test and the 2-sample t test.
RESULTS
The primary indication for early TN was surgical transplant complications (94.1%), with 58.8% of these cases requiring emergency surgery. Morbidity (major complications) occurred in 47.1% of cases, and mortality was 5.9%. In contrast, graft intolerance syndrome was the leading indication for late TN (76.9%), with elective surgery performed in 88.5% of cases. Morbidity (major complications) occurred in 11.5% of cases, and mortality was 3.8%. Within the late TN group, 82.7% of cases were treated with ICAN and 17.3% with ECAN. Blood transfusion was required during surgery in 17.3% of cases, with no significant difference between the groups. Multivariate logistic regression analysis revealed that the timing of surgery was the only statistically significant predictor of complication occurrence.
CONCLUSIONS
Our data suggest that TN can be performed with relatively low morbidity. However, early TN remains the only independent risk factor for developing adverse outcomes.
Keywords: Kidney Transplantation; Nephrectomy; Transplant Recipients
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