title: Role of allograft nephrectomy following kidney graft failure: preliminary experience with pre-operative angiographic kidney embolization.
abstract: BACKGROUND
  Allograft nephrectomy (AN) is not without morbidity following graft failure (GF) in kidney transplantation (KT).
  
  
  METHODS
  Single center retrospective review of all adult patients undergoing AN following KT, including a subset of patients who underwent pre-operative angiographic kidney embolization (PAKE).
  
  
  RESULTS
  Over a 104 month period, 853 adult patients underwent deceased donor KT. With a median follow-up of 3.5 years, 174 patients (20.4%) developed GF and 38/174 (21.8%) underwent AN. The rate of AN was higher in patients with delayed graft function [DGF, Odds Ratio (OR) 2.15, p = 0.023] and early GF (OR 1.7, p = 0.064). For patients undergoing PAKE (n = 13, mean timing of AN 27.5 months post-KT), the estimated intra-operative blood loss was reduced from a mean of 375 ± 530 to 100 ± 162 ml (p < 0.10), mean peri-operative transfusion requirements were reduced from 3.36 ± 4.8 to 0.23 ± 0.44 units (p < 0.05), and total mean operating time was reduced from 192 ± 114 to 141 ± 38 min (p = NS) compared to 13 control patients undergoing AN in the absence of vascular thrombosis or PAKE. Mean length of hospital stay was decreased from 8.5 ± 9 to 5.5 ± 3 days (p = NS) in patients with PAKE. Surgical complication and infection rates and hospital charges were comparable.
  
  
  CONCLUSIONS
  Delayed graft function and early GF are associated with a higher rate of AN. PAKE may result in less blood loss, fewer transfusions, reduced operating time, and shorter length of stay, which may translate into reductions in morbidity.
authors.affiliation: Department of General Surgery, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
authors.forename: Samer M T
authors.initials: SM
authors.lastname: Al-Geizawi
authors.forename: Rajinder P
authors.initials: RP
authors.lastname: Singh
authors.forename: Jack M
authors.initials: JM
authors.lastname: Zuckerman
authors.forename: Jay A
authors.initials: JA
authors.lastname: Requarth
authors.forename: Alan C
authors.initials: AC
authors.lastname: Farney
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rogers
authors.forename: Jacob
authors.initials: J
authors.lastname: Taussig
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Orlando
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stratta
mesh_terms: D000328:Adult; D064591:Allografts; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D051799:Delayed Graft Function / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects; D009657:North Carolina; D016017:Odds Ratio; D061646:Operative Time; D011300:Preoperative Care; D015641:Radiography, Interventional / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure