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Related Experiment Videos

Nephrectomy after transplant failure: current practice and outcomes.

O Johnston1, C Rose, D Landsberg

  • 1Division of Nephrology, University of British Columbia, St. Paul's Hospital, Vancouver, B.C., Canada.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|July 10, 2007
PubMed
Summary
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Transplant nephrectomy after graft failure has differing outcomes. Early graft failure with nephrectomy increased death risk, while late graft failure with nephrectomy decreased it. Further study is needed.

Area of Science:

  • Nephrology
  • Transplant Surgery
  • Clinical Outcomes Research

Background:

  • The clinical utility of transplant nephrectomy following kidney transplant failure remains unclear.
  • Kidney transplant failure necessitates management decisions, including potential nephrectomy.

Purpose of the Study:

  • To investigate the association between transplant nephrectomy and patient survival and repeat transplant failure in patients experiencing kidney transplant failure.
  • To differentiate outcomes based on the timing of transplant failure (early vs. late).

Main Methods:

  • Retrospective analysis of 19,107 kidney transplant failure patients from 1995-2003 in the United States.
  • Comparison of outcomes (death, repeat transplant failure) between patients who underwent nephrectomy and those who did not, stratified by early (<12 months) and late (>=12 months) graft survival.

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Main Results:

  • In early transplant failure, nephrectomy (56% of cases) was linked to increased mortality (HR 1.13) and decreased repeat transplant failure (HR 0.72).
  • In late transplant failure, nephrectomy (27% of cases) was associated with decreased mortality (HR 0.89) and increased repeat transplant failure (HR 1.20).

Conclusions:

  • The impact of transplant nephrectomy on outcomes differs significantly based on the timing of kidney transplant failure.
  • Observational data suggest potential benefits in reduced mortality with nephrectomy in late failure, but risks in early failure.
  • Prospective studies are warranted to clarify the role of nephrectomy in managing dialysis-dependent transplant failure and its implications for re-transplantation.