Transplant nephrectomy

Table 1 Indications for transplant nephrectomy

Type	Reason	Comments
Cause of failure	Renal vein thrombosis	Transplant pyonephrosis
	Renal artery occlusion
	Acute rejection refractory to treatment[17]
	Sepsis
Allograft associated complications	Primary non function	Apart from tumors, these occur in the early phase after transplantation
	Bleeding post biopsy[17]
	Transplant rupture[18]
	Rupture of pseudoaneurysm
	Malignant tumors[18]
Following failure	Pain due to uncontrolled rejection[5]
	Graft tenderness[14]
	Anemia resistant to treatment
	Recurrent urinary tract infection
	Persistent hematuria
	Sepsis
Miscellaneous	Preliminary measure prior to re-transplantation[19]	For example, failed kidney-pancreas transplant awaiting combined re-transplantation
	Recurrence of primary disease
	Polyoma virus nephropathy

Table 2 Techniques of transplant nephrectomy

	Extracapsular	Intracapsular
Description of technique[43]	Dissection outside kidney capsule to remove kidney including capsule, ureter and most of the transplant vessels	Dissection within kidney capsule which is densely ardent to surrounding tissues by the time of late graft removal
Mean procedure time[35]	125.3 min	109.4 min
Blood loss[35]	385 (60-1500) mL	638 (70-2200) mL
Blood transfusion[35]	6/17 (35.3%)	16/30 (53.3%)
Complication rate[35]	3/17 (17.6%)	6/30 (20%)
Comments	Suitable for early graft failures	Generally used for late graft failures

Table 3 Complications of transplant nephrectomy

Complication	Comments
Hemorrhage	Commonest problem
Hematoma
Infection: superficial deep	Extremely high in earlier series[39]
Lymphocele
Pseudoaneurysm of iliac vessels	Treat by endovascular techniques
Urinary fistula
Bowel injury
Injury to obturator nerve or lateral cutaneous nerve of the thigh	Uncommon
Miscellaneous

Table 4 Effect of transplant nephrectomy on subsequent transplant function

Study	TN	No	PRA (%) > 30%	HLA (mm)	Delayed graft function (%)	Acute rejection (%)	Graft survival (%)		Comments
							1 yr	5 yr
Sumrani et al[14], 1992	Yes	35	57		63				AR rates similar between groups
	No	52	33		30
Yagmurdur et al[16], 2005	Yes	21		1.9 ± 1.1		43	83	45	Retrospective
	No	32		1.0 ± 0.6		38	69	68	TN has no advantage
Johnston et al[10], 2007	Yes	6213	14.7	64.8%1	33.6				USRDS 1995-2003
	No	12 894	12.6	53.4%1	24.4				Early TN associated with lower risk of transplant failure
Ahmad et al[15], 2009	Yes	68	372			49.1	83.8	66.2	PRA level significantly influences graft survival independent of TN
	No	21	292			31.2	94.7	69.5
Schleicher et al[19], 2011	Yes	121	16	2.2 ± 1.5	29.3	29.7			Retrospective study
	No	45	2	2.0 ± 1.7	20	13.3			Graft survival worse in TN group

¹4-6 mismatches;

²Proportion of positive patients.