[Early failures in kidney transplantation. A retrospective study of 53 cases]

Among the 652 consecutive renal transplants performed from January 1973 through December 1988, all graft failures within 60 days of transplantation were retrospectively analyzed. The 53 early failures were divided into four groups on the basis of pathologic findings in the removed transplant). 1) Irreversible vascular rejection (17 cases); in ten patients, this rejection occurred between the fourth and eight days and was manifested by uniform clinical features. 2) Thrombosis of the renal artery (18 cases), with several subgroups: a) early postoperative thrombosis (5 cases) with primary anuria; b) thrombosis following reoperation (6 cases) for urine leakage or occlusion; c) thrombosis with a clotting disorder,; d) and five cases of thrombosis with clinical manifestations of vascular rejection but with isolated thrombosis upon histologic examination. 3) Thrombosis of the renal vein (12 cases), with primary anuria in nine cases, and rupture of the kidney in three. 4) The last group includes six cases due to a variety of causes: one immediately non-viable -kidney, two severe, irreversible cases of tubulonephritis, one cortical necrosis secondary to circulatory collapse in the recipient, one complete necrosis of the ureter requiring removal of the transplant, and one immediate recurrence of hemolytic uremic syndrome. Among the risk factors for early failure, attention is drawn to the young age of the donor or recipient that increases the risk of thrombosis. Furthermore, the risk of vascular rejection was decreased in patients preventively treated by OKT3.