Intolerance syndrome in failed renal allografts: incidence and efficacy of percutaneous embolization

Immunologic intolerance to a failed renal allograft left in situ is referred to as graft intolerance syndrome, the incidence and predictors of which are unknown. Treatment by transcatheter vascular embolization has been reported to be less invasive than transplantectomy. The incidence of graft intolerance syndrome and results of transcatheter vascular embolization as a first therapeutic approach were studied.

A retrospective study of 149 transplant recipients who returned to dialysis therapy between June 1989 and December 2001 was performed. After immunosuppression withdrawal, a diagnosis of graft intolerance syndrome was made based on clinical criteria and confirmed by the persistence of renal perfusion under imaging procedures. Potential immunologic predictors were analyzed.

Of 149 patients with failed renal allografts, 55 patients (37%) developed graft intolerance syndrome during follow-up (27.5 +/- 34.5 months; range, 1 to 173 months). Manifestations of graft intolerance syndrome were fever (88%), flu-like symptoms (33%), hematuria (39%), local pain (53%), and increased graft size (51%). Most episodes of graft intolerance syndrome appeared within 6 months (virtually all presented within 24 months after graft failure). None of the immunologic variables studied showed an influence on graft intolerance syndrome. Transcatheter vascular embolization was performed in 48 patients and was successful in 31 patients (65%). A second embolization was necessary in 8 patients. No deaths or severe complications were observed. Eleven patients (22%) underwent transplantectomy because of persistent graft intolerance syndrome (n = 8) or graft infection (n = 3).

Graft intolerance syndrome is common in patients with failed renal allografts left in situ, especially within the first year of returning to dialysis therapy. Our data support transcatheter vascular embolization as first-line therapy for patients with symptomatic failed renal allografts, although 1 in 4 patients will require transplantectomy.