Nonfunctioning renal allograft embolization as an alternative to graft nephrectomy: report on seven years' experience.
OBJECTIVE
Graft nephrectomy is the treatment of choice in patients with graft intolerance syndrome, but it is associated with high morbidity and mortality rates. Renal vascular embolization has been suggested as a possible alternative. The aim of this study was to evaluate the efficacy and safety of arterial embolization of these nonfunctioning transplanted kidneys.


METHODS
Twenty-six transplanted kidneys in 25 patients with irreversible renal graft rejection and graft intolerance who underwent arterial embolization at our center from August 1994 to April 2001 were analyzed for procedural success and long-term outcome. Embolization was performed with absolute alcohol or with polyvinyl alcohol (Ivalon) and coils.


RESULTS
Twenty-four of the 26 (92%) procedures were technically successful, but in one patient only partial occlusion of one of two renal arteries was achieved, and in another the renal artery was already completely occluded. There were two major complications: emphysematous pyelonephritis necessitating nephrectomy and groin abscess that was drained. Follow-up ranged from 8 to 84 months. Clinical success was achieved in 24 of the 26 procedures (92%), and only in one patient did embolization fail to relieve the symptoms, and nephrectomy was performed 3 months later.


CONCLUSIONS
Renal vascular embolization is a simple, safe and effective technique for the treatment of nonfunctioning renal allografts associated with graft intolerance syndrome. We suggest that it be considered the treatment of choice.
Atar
Eli
E
Department of Radiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Belenky
Alexander
A
Neuman-Levin
Margalit
M
Yussim
A
A
Bar-Nathan
Nathan
N
Bachar
Gil N
GN
D000293:Adolescent; D000328:Adult; D002648:Child; D004621:Embolization, Therapeutic; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000628:therapy*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011145:Polyvinyls / Q000627:therapeutic use*; D016896:Treatment Outcome
D011145:Polyvinyls; C026699:ivalon sponge; D000431:Ethanol