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Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach
Published on: May 7, 2019
Transplantectomy following renal graft failure
Gloria Antón-Pérez1, Roberto Gallego-Samper, Silvia Marrero-Robayna
1Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria.
Abstract:
Approximately 4%-10% of incident patients on dialysis have a non-functioning kidney graft, and according to series, as many as 32% require transplantectomy for a variety of reasons. Mortality in these patients is significantly higher than in those with a functioning graft or on renal replacement therapy without having received a graft. Graft intolerance syndrome, early graft loss, severe proteinuria, recurring pyelonephritis or neoplasia, and chronic inflammation syndrome have all been proposed as indications for transplantectomy. Chronic inflammation syndrome occurs in patients with high levels of inflammatory markers (C-reactive protein), anaemia resistant to treatment with erythropoiesis stimulators, and malnutrition markers. This inflammatory state is provoked by the graft, and reverts when a transplantectomy is performed, as several studies have shown. We have reviewed the medical literature published on this topic, the indications for transplantectomy and embolectomy, their advantages and disadvantages, the incidence of graft intolerance syndrome, and the pathophysiology of chronic inflammation syndrome, as well as the currently proposed therapeutic management algorithm.
Insights
Kidney transplantectomy is necessary for 32% of non-functioning grafts, improving outcomes. Removing the non-functioning graft resolves chronic inflammation syndrome, a serious complication in dialysis patients.
Area of Science:
- Nephrology
- Transplant Surgery
Background:
- 4%-10% of dialysis patients have non-functioning kidney grafts.
- Up to 32% of these may require transplantectomy due to various complications.
- Mortality is significantly higher in patients with non-functioning grafts compared to alternatives.
Purpose of the Study:
- To review medical literature on transplantectomy and embolectomy.
- To outline indications, advantages, and disadvantages of transplantectomy.
- To discuss graft intolerance syndrome and chronic inflammation syndrome.
Main Methods:
- Literature review of medical publications.
- Analysis of indications for transplantectomy and embolectomy.
- Examination of graft intolerance and chronic inflammation syndrome.
Main Results:
- Transplantectomy is indicated for graft intolerance, early graft loss, proteinuria, pyelonephritis, neoplasia, and chronic inflammation syndrome.
- Chronic inflammation syndrome is characterized by high C-reactive protein, resistant anemia, and malnutrition.
- Graft removal resolves the inflammatory state in chronic inflammation syndrome.
Conclusions:
- Transplantectomy is a crucial intervention for specific complications of non-functioning kidney grafts.
- Understanding graft intolerance and chronic inflammation syndrome is key to patient management.
- A therapeutic management algorithm for these conditions is proposed.
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