[Indications for transplant nephrectomy with reference to possible complications]

Mortality rates of 1.2-38% and morbidity rates up to 68% following transplant nephrectomy (TPL-X) have been reported in the literature. From 1988 to 1995, 40 TPL-X were performed in the transplant centre in Bremen. In 15 cases the organs were removed within the first 6 weeks after renal transplantation. The indications were infarction in 10 cases, hyperacute/acute rejection in 3 cases, and repeated rejections with irreversible functional disorder in 2 cases. In the 25 patients in whom TPL-X was performed later than 6 weeks after transplantation the indication was chronic rejection associated with clinical findings in every case. The overall mortality rate was zero in the first 6 weeks after TPL-X, and the morbidity rate, 20%. TPL-X is a re-operation in patients with chronic disease. From this point of view the complication rate with a subtle technique is acceptable. The indications for TPL-X have not been well defined in the literature, so that the decision as to whether or not TPL-X is indicated is made on the basis of the individual situation. TPL-X seems not to be necessary in all cases of transplant failure.