Outcomes and Indications of Early vs Late Allograft Nephrectomy: A Retrospective Analysis From a Tertiary Center

Renal allograft nephrectomy remains a complex and high-risk procedure, often performed following graft failure. While its indications and outcomes vary, the optimal timing for nephrectomy remains controversial.

To compare early (≤60 days post-transplant) vs late (>60 days) allograft nephrectomies in terms of clinical indications, surgical outcomes, complications, and mortality in a tertiary care center.

We conducted a retrospective observational study including all patients undergoing renal allograft nephrectomy between January 2010 and July 2024. Patients were stratified into early and late nephrectomy groups. Data were analyzed regarding demographic characteristics, indications, urgency, surgical technique, complications (Clavien-Dindo classification), transfusion requirements, length of stay, and follow-up outcomes.

Among 109 nephrectomies (11.0% of 985 transplants), 55 were early and 54 were late. Early nephrectomies were more frequently urgent (87.3% vs 29.6%, P < .001) and associated with higher transfusion rates, longer hospitalization (median 16 vs 10 days, P = .011), and more complications (22.8% vs 12.7%, P = .164). Major indications differed: vascular thrombosis and hemorrhagic shock were predominant in early nephrectomies, while chronic rejection and infection prevailed in late cases. Urgent nephrectomies, irrespective of timing, were linked to significantly higher complication rates (P < .001). No intraoperative deaths occurred, but all 3 postoperative deaths were in the early group.

Early allograft nephrectomies, typically performed for urgent complications, are associated with increased morbidity, transfusion needs, and hospital stay. Late nephrectomies, often elective, have been associated with better postoperative outcomes. These findings underscore the need for standardized guidelines and prospective studies to optimize the management of failed renal grafts.