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Selective pre-transplant nephrectomy: indications and perioperative management
The Journal of Urology
|March 1, 1985
Summary
Selective pre-transplant nephrectomy is a safe and effective procedure for select kidney transplant candidates, sparing most from major surgery. Vigorous fluid management and prompt dialysis are key to preventing complications.
Area of Science:
- Nephrology
- Transplantation Surgery
- Urology
Background:
- 198 patients were candidates for renal transplantation between 1977 and 1983.
- 14 patients underwent selective pre-transplant nephrectomy.
Purpose of the Study:
- To review the experience with selective pre-transplant nephrectomy.
- To evaluate the safety and efficacy of the procedure and perioperative management.
Main Methods:
- Patients underwent dialysis 1 day preoperatively and within 29 hours postoperatively.
- Careful monitoring of perioperative fluid losses with vigorous replacement therapy was employed.
- Indications included pyelonephritis, urinary tract abnormalities, hypertension, Goodpasture's disease, glomerulonephritis, and polycystic kidneys.
Main Results:
- No postoperative deaths occurred in the 14 patients.
- There were 8 complications among the patients who underwent the procedure.
- 93% of potential renal transplant candidates were spared major surgery.
- No patient required removal of original kidneys post-transplant.
Conclusions:
- Selective pre-transplant nephrectomy is beneficial for carefully selected patients.
- Vigorous fluid replacement and prompt postoperative dialysis are safe and effective.
- This approach averts complications seen with minimal fluid administration and delayed dialysis.