Indication and surgical technique for transplant nephrectomy

Rhew, Hyun Yul; Chang, Jin Ho

Abstract

The criteria for removal of failed renal allografts are not clearly defined. Between December, 1985 and June. 1991, 269 renal transplantations were performed at Kosin Medical Center, Pusan, Korea. Of these 29 lost renal allograft and transplant nephrectomy was carried out within 6 weeks of transplantation in 4 instances: 1 case because of ABO incompatibility and 3 due to oliguria, progressively increasing serum creatinine and enlarged tender graft despite of pulsing therapy. Of these a patients, one patient had rupture of transplanted kidney, 4 kidney allografts were removed at least 6 months after transplsntation: three had graft pain and tenderness, graft enlargement and persistent gross hematuria. The surgical approach was carried out through the transplantation incision. In the postoperative period, there were some complications: 2 of these were wound hematoma and bleeding which resulted in no further complication but in one case immediately after transplant nephrectomy sepsis resulted in death. In conclusion, absolute indication for tansplant nephrectomy was hyperacute rejection and if chronic rejection was present, it should be considered with clinical findings. During removal of the transplanted kidneys, we think it is benefit that the vessels were ligated "en mass".