title: Transplantectomy following renal graft failure.
abstract: Approximately 4%-10% of incident patients on dialysis have a non-functioning kidney graft, and according to series, as many as 32% require transplantectomy for a variety of reasons. Mortality in these patients is significantly higher than in those with a functioning graft or on renal replacement therapy without having received a graft. Graft intolerance syndrome, early graft loss, severe proteinuria, recurring pyelonephritis or neoplasia, and chronic inflammation syndrome have all been proposed as indications for transplantectomy. Chronic inflammation syndrome occurs in patients with high levels of inflammatory markers (C-reactive protein), anaemia resistant to treatment with erythropoiesis stimulators, and malnutrition markers. This inflammatory state is provoked by the graft, and reverts when a transplantectomy is performed, as several studies have shown. We have reviewed the medical literature published on this topic, the indications for transplantectomy and embolectomy, their advantages and disadvantages, the incidence of graft intolerance syndrome, and the pathophysiology of chronic inflammation syndrome, as well as the currently proposed therapeutic management algorithm.
authors.affiliation: Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria.
authors.forename: Gloria
authors.initials: G
authors.lastname: Antón-Pérez
authors.forename: Roberto
authors.initials: R
authors.lastname: Gallego-Samper
authors.forename: Silvia
authors.initials: S
authors.lastname: Marrero-Robayna
authors.forename: Fernando
authors.initials: F
authors.lastname: Henríquez-Palop
authors.forename: José C
authors.initials: JC
authors.lastname: Rodríguez-Pérez
mesh_terms: D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology; D009392:Nephrectomy; D011183:Postoperative Complications / Q000601:surgery*; D051437:Renal Insufficiency / Q000276:immunology / Q000601:surgery*