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Mouse Kidney Transplantation: Models of Allograft Rejection
Published on: October 11, 2014
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Indications, risks and impact of failed allograft nephrectomy
Lisa Ghyselen1, Maarten Naesens1
1Department of Microbiology and Immunology, KU Leuven, University of Leuven, Leuven, Belgium; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.
Transplantation Reviews (Orlando, Fla.)
|September 22, 2018
Summary
Nephrectomy after kidney transplant failure has risks and benefits. While not clearly improving retransplant outcomes, it increases HLA antibody sensitization, especially in high-risk patients, arguing against routine use.
Area of Science:
- Nephrology
- Transplant Surgery
- Immunology
Background:
- Kidney transplant graft failure necessitates decisions regarding management of the non-functioning allograft.
- Nephrectomy of a failed allograft is performed in some centers but carries significant morbidity and mortality.
- There is considerable variation in the practice of allograft nephrectomy across different medical centers.
Purpose of the Study:
- To review the indications, surgical aspects, benefits, and risks of nephrectomy following kidney allograft failure.
- To evaluate the impact of allograft nephrectomy on outcomes after retransplantation.
- To assess the association between allograft nephrectomy and the development of HLA antibodies.
Main Methods:
- A systematic review of thirteen retrospective studies was conducted using Medline (PubMed) and Embase databases.
- Studies compared outcomes of retransplantation in patients who underwent allograft nephrectomy versus those who did not.
- Analysis focused on retransplant graft survival, patient survival, and the incidence of HLA antibody development.
Main Results:
- Allograft nephrectomy is associated with significant morbidity (20-30% complication rate) and mortality (0-11% rate).
- Most studies (9/13) found no significant difference in retransplant graft survival between patients with and without prior allograft nephrectomy.
- Allograft nephrectomy is linked to an increased risk of HLA antibody development, though the exact mechanism is unclear.
Conclusions:
- The available literature does not demonstrate a clear advantage or disadvantage of allograft nephrectomy regarding retransplant outcomes.
- The increased risk of HLA antibody sensitization, particularly in high-risk patients, suggests that routine allograft nephrectomy should be avoided in asymptomatic patients eligible for retransplantation.
- Further investigation is needed to understand the mechanisms behind increased HLA antibody levels post-nephrectomy, including the role of immunosuppression withdrawal.
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