[Percutaneous embolization of non-functioning renal graft as therapeutic alternative to surgical transplantectomy]

To analyze the indications, results and complications of embolisation of a non-tolerated, non-functioning renal graft with regards to surgical transplantectomy.

Between 1990 and 1998, 55 patients with failed renal graft were studied. Patients had undergone either subcapsular transplantectomy (23 patients) or percutaneous embolisation of allograft (32 patients). Mean age in both groups was 40.9 +/- 3.14 and 42 +/- 2.45 years respectively. After start of dialysis, the graft was left in situ for an average of 10.2 (+/- 11.2) and 9.9 (+/- 6.5) months. Hospital stay, occurrence of complications from the technique used, and results were compared.

Post-embolisation syndrome (high temperature for 2 to 5 days) was seen in 59% cases. No major complications secondary to embolization were seen, whereas 13% subcapsular nephrectomies had complications that required re-operation. Hospital stay was shorter (p > 0.005) in embolized patients than in those undergoing surgery. Sings and symptoms of intolerance disappears in 84.4% embolizations. Results were unsuccessful in 5 grafts (15.6%) undergoing embolisation, which resulted in deferred subcapsular transplantectomy.

Long-term, embolization shows acceptable control over the signs and symptoms of intolerance and involves less morbidity than transplantectomy. Surgery is useful when intolerance persists after one or more embolizations. Because of its features of safety and effectiveness, embolisation should be a choice treatment in selected cases.