[Management of non-functioning renal graft]

On a series of 315 consecutive Renal Transplants (RT), the authors analyze the effects from any situation capable of causing the graft's renal failure, whether accompanied or not of oligoanuria. To begin with, the exploratory approach promoted by the ¿non-functioning kidney¿ is established recognizing three typical stages depending on the time of appearance: early, medium-term and long-term. The breakthroughs obtained in the prevention of Acute Tabular Necrosis (A.T.N.) are verified through the use of the receptor's hyperhydration, as well as the good results in the treatment of rejection since the arrival of Cyclosporin and the recent introduction of OKT3. Chronic rejection, is, today, the major cause of our transplantectomies (TX), since our attitude towards the exeresis of all irreversibly non-functioning grafts is well known. Vascular thrombotic problems have a very high percentage of losses among affected kidneys. Little can be done once the problem arises. Prevention is the best weapon available and special attention should be paid to the meticulousness of bank surgery and the suitable final positioning of the organ in the fossa iliaca, having into account the highly close relationship between this problem and the pathological and iatrogenic anomalies displayed by the organs to be transplanted in their arterial tree. The excretory tract problems are repaired in 83% cases, but the rest may even result in the loss of the kidney. In these complications, early surgery is the best way to avoid subsequent amputation surgery.