Indications, risks and impact of failed allograft nephrectomy

Transplantation Reviews
Lisa Ghyselen, Maarten Naesens

Abstract

In this review, we describe the indications, surgical aspects, benefits and risks of nephrectomy after graft failure. There is a great variation in the number of allograft nephrectomies performed among different centers. Nephrectomy of a failed allograft is associated with significant morbidity and mortality with a complication rate of 20-30% and mortality rates between 0% and 11%. A systematic review through Medline (Pubmed) and Embase identified thirteen retrospective studies that compared patients with and patients without allograft nephrectomy prior to retransplantation. Allograft nephrectomy associates with an increased risk of HLA antibody development. With two recent studies that used the more sensitive HLA antibody detection methods disproving the hypothesis of intragraft adsorption of HLA antibodies, the mechanism leading to the increased HLA antibody levels is not clear, but the role of immunosuppression withdrawal is becoming clear and needs further investigation. In nine of the thirteen studies that evaluated the impact of allograft nephrectomy on outcome in retransplantation, retransplant graft survival was not significantly different among patients with and patients without allograft nephrectomy. Only three studie...Continue Reading

Citations

Oct 22, 2019·Transplantation·Elisabet Van LoonMaarten Naesens
Apr 2, 2020·Biomedicines·Covadonga López Del Moral CuestaJuan Carlos Ruiz San Millán
Jan 31, 2020·Transplantation·Elisabet Van LoonMaarten Naesens
Feb 11, 2021·Clinical Kidney Journal·Marco FiorentinoGiuseppe Castellano
Mar 12, 2021·Clinical Journal of the American Society of Nephrology : CJASN·Scott Davis, Sumit Mohan
Jun 12, 2021·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Michelle LubetzkyTarek Alhamad
Jun 2, 2021·Transplant International : Official Journal of the European Society for Organ Transplantation·Paschalis GavriilidisDeb Roy

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