Ramírez-Aboites CF, Meza-Jiménez G, Bernáldez-Gómez G, Robledo-Meléndez A, Cano-Vargas B, Payán-Rosete JA, Carreño-Rodríguez Y, Cruz-Santiago J

Language: Spanish
References: 13
Page: 29-35
PDF size: 279.18 Kb.

ABSTRACT

Introduction: kidney transplantation is the therapy of choice for most causes of end-stage chronic renal failure, improving quality of life and survival compared to dialysis. The number of kidney transplants in Mexico prior to the SARS-CoV-2 pandemic was constantly increasing. At the same time, advances in immunosuppression and accumulated experience have made possible greater survival of both the patient and the graft. However, between 5 and 38% of these transplants end up being removed. a total of 2,324 kidney transplants have been performed from 1979 to June 2022. 4-10% of incident dialysis patients have a non-functioning kidney graft. These patients may present a syndrome of immunological intolerance clinically characterized by fever, without underlying infectious process, hematuria, pain, and enlarged graft. This situation, like early graft loss (in the first year after transplantation), constitutes a clear indication for transplantectomy or embolization, depending on the case. Objective: to conduct a review of the experience and incidence of renal graft transplantectomy in the group of the Renal Transplant Unit of the High Specialty Medical Unit of the "Dr. Antonio Fraga Mouret" Specialty Hospital National Medical Center La Raza (UMAE HECMR) from January 2019 to June 2022, as well as a review of the literature. Results: a total of 2,324 kidney transplants performed at the UMAE HECMR, have been carried out 258 in the period from January 2019 to June 2022. During the period studied, 11 renal graft transplantectomies representing 4.26%. The following parameters were analyzed in the traplantectomies performed: gender, age, causes that motivated the procedure, technique used, among others. Conclusion: despite the scant accumulated medical evidence on the attitude to be taken with patients who carry non-functioning grafts on their return to dialysis, the indication for transplantectomy in the presence of graft intolerance syndrome is clearly established, with notable clinical improvement after performing the procedure.

REFERENCES

1. Rao PS, Schaubel DE, Jia X, Li S, Port FK, Saran R. Survival on dialysis post-kidney transplant failure: Results from the scientific registry of transplant recipients. Am J Kidney Dis. 2007; 49: 294-300.

2. Marcen R, Teruel JL. Patient outcomes after kidney allograft loss. Transplant Rev (Orlando). 2008; 22: 62-72.

3. Kaplan B, Meier-Kriesche HU. Death after graft loss: an important late study endpoint in kidney transplantation. Am J Transplant. 2002; 2: 970-974.

4. Gill JS, Pereira BJG. Death in the first year after kidney transplantation: Implications for patients on the transplant waiting list. Transplantation. 2003; 75: 113-117.

5. Pérez-Flores I, Sánchez-Fructuoso A, Marcén R, Fernández A, Fernández Lucas M, Teruel JL. Manejo del injerto renal fallido. Nefrectomía versus embolización. Nefrologia. 2009; 29 (Sup. 1): 54-61.

6. Pérez Martínez J, Gallego E, Juliá E, Llamas F, López A, Palao F et al. Embolization of non-functioning renal allograft: efficacy and control of systemic inflammation. Nefrologia. 2005; 25 (4): 422-427.

7. Sharma DK, Pandey AP, Nath V, Gopalakrishnan G. Allograft nephrectomy--a 16-year experience. Br J Urol. 1989; 64 (2): 122-124.

8. González-Satué C, Riera L, Franco E, Escalante E, Dominguez J, Serrallach N. Percutaneous embolization of the failed renal allograft in patients with graft intolerance syndrome. BJU Int. 2000; 86: 610-612.

9. UNOS Registry Data, 2009. Available in: http://optn.transplant.hrsa.gov

10. Ballesteros Sampol JJ. Trasplantectomía extracapsular sistemática del injerto renal no funcionante. Actas Urol Esp.1994; 18 (Supl): 532-540.

11. Moore TC, Hume DM. The period and nature of hazard in clinical renal transplantation. I. The hazard to patient survival. Ann Surg. 1969; 170 (1): 1-11.

12. Chiverton SG, Murie JA, Allen RD, Morris PJ. Renal transplant nephrectomy. Surg Gynecol Obstet. 1987; 164 (4): 324-328.

13. Montañés P, Torrubia EJ, Espinosa J, Cruz N, Sánchez E, León E. Estudio multicéntrico. Complicaciones quirúrgicas del trasplante renal en España. Análisis de datos. En complicaciones quirúrgicas del trasplante renal. Ponencia al LVII Congreso Nacional de Urología. Madrid: 1992. p. 261.