Risk Factors of Early Kidney Graft Transplantectomy

Kidney allograft explant in the first month after transplant is a major concern for medicosurgical teams specialized in kidney transplantation and unacceptable graft loss in the current shortage. The aim of our study was to evaluate the risk factors of early kidney graft explant.

We retrospectively analyzed all adult kidney transplantations performed at our center from January 2006 to December 2011. Recipient, donor, and transplant characteristics were collected, as well as operating data and early postoperative complications. Univariate and multivariate logistic regression models were used to determine risk factors of early renal allograft explant.

From a total of 707 kidney transplantations, 28 transplantectomies were performed in the first month following transplantation (3.96%). The average delay in days ± SD was 7.6 ± 10. Eighty-six percent of transplantectomies were due to vascular complications. In multivariate analysis, obesity (odds ratio [OR] = 9.6; 95% confidence interval [CI], 1.63-56.5; P = .0007), range of transplantation (OR = 36.89; 95%CI, 5.5-245; P = .0006), intraoperative complications (OR = 3.99; 95%CI, 1.22-13; P = .026), and early postoperative vascular complications (OR = 85.15; 95%CI, 23.6-306; P < .0001) were independent risk factors. Neither donors nor graft characteristics were significant.

Early renal graft transplantectomies are rare but account for 50% of renal graft loss in the first year. Because obesity, perioperative complications, and early vascular complications are independent factors associated with early transplantectomies, their prevention should be based on meticulous surgery during organ procurement, implantation of the kidney, and on the rehabilitation of future recipients.