title: Cumulative incidence, indications, morbidity and mortality of transplant nephrectomy and the most appropriate time for graft removal: only nonfunctioning transplants that cause intractable complications should be excised.
abstract: OBJECTIVE
  We assessed the cumulative incidence of transplant nephrectomy in our population of patients who underwent transplantation and those in whom the transplant failed due to immunological causes. Transplant nephrectomy indications, morbidity and mortality were analyzed to establish the most appropriate time for graft removal.
  
  
  METHODS
  We included all patients who underwent transplantation and graft removal at our institution from January 1, 1970 through January 1, 2000. We estimated the noncumulative incidence of transplant nephrectomy, morbidity and mortality. The cumulative incidence of transplant nephrectomy was estimated by Kaplan-Meier curves.
  
  
  RESULTS
  Of the 631 renal transplants performed in 598 patients we studied a total of 91 transplant nephrectomies in 85 patients. The cumulative incidence of transplant nephrectomy 15 years after the date of transplantation was 25% (95% CI 14 to 40). The cumulative incidence of transplant nephrectomy at 10 years after the date of return to dialysis was 74% (95% CI 49 to 90). The main indication for transplant nephrectomy was graft related complications associated with chronic rejection in 58.2% of cases. The morbidity rate was 48.3% (95% CI 37.7 to 59). Hemorrhagic events were the chief complication. In 7 patients there was a total of 10 reoperations (10.9%, 95% CI 5.3 to 19.2). The mortality rate was 7% (95% CI 2.6 to 14.7). These patients died of sepsis. Urgent transplant nephrectomies had statistically higher morbidity and mortality (p <0.01 and 0.002, respectively).
  
  
  CONCLUSIONS
  Most transplant nephrectomies were performed within 2 years of the transplant date and almost half were done within year 1 after the return to dialysis. The advent of cyclosporine significantly decreased the transplant nephrectomy rate at the expense of fewer graft failures but not at the expense of a lower amount of graft related symptoms after patients returned to dialysis. Bleeding was the leading cause of morbidity and infection was the main cause of mortality. Considering the high morbidity and mortality of transplant nephrectomy, and the potential benefits of leaving nonfunctioning grafts in situ our current policy is to remove the graft only in cases of failed transplants that cause intractable complications.
authors.affiliation: Urology Service, University Hospital Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina.
authors.forename: Fernado Pablo
authors.initials: FP
authors.lastname: Secin
authors.forename: Agustin Roberto
authors.initials: AR
authors.lastname: Rovegno
authors.forename: María
authors.initials: M
authors.lastname: del Rosario Brunet
authors.forename: Rodolfo Emilio José
authors.initials: RE
authors.lastname: Marrugat
authors.forename: Maria
authors.initials: M
authors.lastname: Dávalos Michel
authors.forename: Hector
authors.initials: H
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate