Graft Embolization versus Nephrectomy in Patients with Graft Intolerance and Infection: A Retrospective Cohort Study

After graft failure, kidney transplant recipients may develop immunological intolerance to the allograft left in situ. In such cases, surgical removal of the allograft is usually performed, but is associated with substantial morbidity and mortality. A less invasive option is percutaneous embolization of the renal artery. Here, we describe our clinical experience with embolization and report observed differences with graft nephrectomy.

In this retrospective, single-center study, we included kidney transplant recipients who underwent either graft nephrectomy or embolization between 2018 and 2024. Patients with indication "gain of space" were excluded. We reported on major post-procedural complications within three months (Clavien Dindo score 3-4), post-embolization syndrome, blood transfusions, length of hospitalization and readmissions, and mortality.

We included 13 embolizations and 32 graft nephrectomies. Major post-procedural complications occurred in 23% after embolization versus 41% after nephrectomy (p = 0.32). Length of hospitalization was shorter after embolization compared to nephrectomy (median 1 vs. 5 days, p = 0.001). Post-embolization syndrome occurred in 9 of 13 patients (69%) and was managed conservatively. One patient with recent graft infections required a subsequent nephrectomy for infected necrosis after embolization. Another patient with residual blood flow after embolization required a nephrectomy for persisting hematuria. Two patients with pre-existing sepsis and bacteriemia died after embolization.

Embolization results in shorter length of hospitalization and is likely associated with a reduced incidence of procedure-related major complications as compared to nephrectomy. Pre-existing sepsis is a risk factor for adverse outcomes after embolization, and recent graft infections should be considered a contra-indication.