Renal transplant nephrectomy in children: can an aggressive approach be recommended?
BACKGROUND
A patient with a failed renal graft is generally approached conservatively, especially when graft failure occurs more than 1 month after transplantation. This approach was the cause of extensive morbidity in our institution and therefore we evaluated the correctness of our approach towards transplanted children.


METHODS
Case histories of 182 renal transplants in 145 patients, performed between 1977 and 1999 were reviewed.


RESULTS
A total of 63 renal grafts failed: 19 between 0-1 month (group 1), 22 between 1 month and 1 yr (group 2) and 22 later than 1 yr after transplantation (group 3). Fifty-three grafts (84%) were removed: 100% of group 1, 86% of group 2 and 68% of group 3. The symptoms that indicated the need for graft removal were fever without a clear infection focus (n = 12), abdominal pain in the transplant area (n = 14), macroscopic hematuria (n = 10) and severe hypertension (n = 22). After transplant nephrectomy pain, fever and macroscopic hematuria completely resolved in all and hypertension resolved in 36% of patients. Transplant nephrectomy-associated morbidity was observed in 38% of the patients with 100% recovery.


CONCLUSIONS
The clinical outcome confirmed the indications for transplant nephrectomy. Our future approach will be more aggressive: as soon as symptoms such as unexplained fever, local pain or macroscopic hematuria appear, graft removal will be performed without delay.
Zerouali
F
F
Department of Pediatric Nephrology, University Medical Center Nijmegen, Nijmegen, The Netherlands.
Levtchenko
E N
EN
Feitz
W F J
WF
Cornelissen
E A M
EA
Monnens
L A H
LA
D006084:Graft Rejection / Q000601:surgery; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D009392:Nephrectomy; D012077:Renal Artery; D012082:Renal Veins; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology; D017211:Treatment Failure