Renal allograft nephrectomy: comparison between clinical and pathological diagnosis

Area of Science:

• Nephrology
• Transplantation Immunology
• Surgical Pathology

Background:

• Allograft dysfunction is a common complication after renal transplantation, potentially leading to graft loss.
• The necessity and outcomes of graft nephrectomy for failed renal transplants remain subjects of debate due to associated morbidity and mortality.
• Accurate diagnosis is critical for managing transplant failure and deciding on graft nephrectomy.

Purpose of the Study:

• To compare clinical diagnoses with pathological findings in patients who underwent graft nephrectomy.
• To evaluate the role of graft nephrectomy in the management of renal transplant failure.

Main Methods:

• Retrospective review of 88 patients undergoing graft nephrectomy over 25 years.
• Re-evaluation of graft pathology slides by a nephropathologist.
• Statistical analysis using ANOVA and Chi-square tests (SPSS 18).

Main Results:

• Clinical diagnoses included chronic rejection (38%), infection (26%), and hematuria (10%).
• Pathological diagnoses revealed necrosis with thrombosis (35%) and isolated necrosis (26%).
• Significant discrepancies were noted between clinical and pathological findings.

Conclusions:

• Necrosis was present in approximately half of the explanted grafts.
• Graft nephrectomy may be avoidable in cases with negative preoperative panel reactivity and no absolute indication, preserving the patient from procedure-related risks.
• Leaving the graft in situ offers benefits like erythropoietin production and calcidiol hydroxylation.