title: Allograft nephrectomy: what is the best surgical technique?
abstract: BACKGROUND
  The objective of this study was to evaluate differences in outcomes of allograft nephrectomies performed by extracapsular versus intracapsular techniques.
  
  
  METHODS
  From 1993 to 2010, we performed 89 allograft nephrectomies, including 57 by extracapsular techniques and 32 by intracapsular, chosen according to feasibility at the beginning of the surgery. Fisher exact test and logistic regression were used for statistical analysis. Survival estimates after allograft nephrectomy were calculated according to the Kaplan-Meier method.
  
  
  RESULTS
  After a mean graft survival of 49.7 months, the indications for transplant nephrectomy were chronic rejection (39.3%), acute rejection (22.5%), infection/sepsis (19.1%), gross hematuria (6.7%), renal vein thrombosis (6.7%), renal artery thrombosis (3.4%), and graft rupture (2.3%). Mean operative time, blood loss, transfusions, and complications were similar between the extracapsular and intracapsular groups. The only difference in surgical aspects between the 2 groups was the mean hospital stay, which was longer for the extracapsular group (13.8 vs 7.6 days; P = .01), a result that was confirmed by multivariate analysis (odds ratio, 1.05; 95% confidence interval, 1.0-1.1; P = .03).
  
  
  CONCLUSIONS
  Our experience showed no significant advantages in favor of the intracapsular technique except for a shorter length of hospital stay than after the extracapsular procedure.
authors.affiliation: Urology, Andrology, and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. antoniovavallo@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Vavallo
authors.forename: G
authors.initials: G
authors.lastname: Lucarelli
authors.forename: C
authors.initials: C
authors.lastname: Bettocchi
authors.forename: M
authors.initials: M
authors.lastname: Tedeschi
authors.forename: S
authors.initials: S
authors.lastname: Palazzo
authors.forename: V
authors.initials: V
authors.lastname: Losappio
authors.forename: L
authors.initials: L
authors.lastname: Gesualdo
authors.forename: G
authors.initials: G
authors.lastname: Grandaliano
authors.forename: F P
authors.initials: FP
authors.lastname: Selvaggi
authors.forename: M
authors.initials: M
authors.lastname: Battaglia
authors.forename: P
authors.initials: P
authors.lastname: Ditonno
mesh_terms: D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D009392:Nephrectomy; D013514:Surgical Procedures, Operative / Q000379:methods*; D014184:Transplantation, Homologous