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[Problems associated with nephrectomy of transplanted kidneys]

M J Martínez Urrutia1, P López Pereira, M Perdiguero

  • 1Dpto. de Cirugía Pediátrica, Hospital Infantil, Madrid.

Cirugia Pediatrica : Organo Oficial De La Sociedad Espanola De Cirugia Pediatrica
|October 1, 1995
PubMed
Summary

In children, failed renal transplants (RT) often require transplant nephrectomy (TN), primarily due to symptomatic rejection. This procedure carries significant risks, highlighting the complexities of pediatric kidney transplant management.

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Area of Science:

  • Pediatric Nephrology
  • Transplant Surgery
  • Immunology

Background:

  • Graft survival in renal transplantation is finite, necessitating management of failed allografts.
  • Understanding the outcomes and complications of failed pediatric renal transplants is crucial for patient care.

Purpose of the Study:

  • To investigate the fate of failed renal transplants (RT) in children.
  • To determine the indications for transplant nephrectomy (TN) in pediatric patients.
  • To assess the morbidity associated with TN following RT failure.

Main Methods:

  • Retrospective analysis of 96 renal transplants performed between 1985 and September 1994.
  • Identification of graft failure causes and subsequent transplant nephrectomy procedures.
  • Evaluation of patient demographics, indications for TN, and postoperative complications.

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Main Results:

  • 31 out of 96 (32.3%) renal transplants failed, with 71% due to immunologic causes.
  • Transplant nephrectomy (TN) was performed in 28 patients (29%), most commonly for symptomatic rejection (35.7%).
  • Postoperative complications included fluid/electrolyte disorders (45.5%), wound hematoma (13.6%), major hemorrhage (7%), and a 4.5% mortality rate.

Conclusions:

  • Children with failed renal allografts frequently require transplant nephrectomy (90% of cases), predominantly due to symptomatic rejection.
  • Transplant nephrectomy in pediatric patients is associated with considerable morbidity and is riskier than native nephrectomy.