title: Allograft nephrectomy: a single-institution, 10-year experience.
abstract: BACKGROUND
  Allograft nephrectomy (AN) is associated with a high number of surgical complications. Some authors advocate that early nephrectomy (<1 year) is associated with fewer complications. Intracapsular (ICAN) and extracapsular AN (ECAN) might have a different impact on allosensitization and surgical outcomes. Our goal was to compare surgical outcomes between early and late AN in our institution and to compare ICAN and ECAN in terms of surgical outcomes and panel reactive antibodies (PRA) variation.
  
  
  METHODS
  Between January 2000 and October 2012, we performed 104 AN at our institution (32 early and 72 late). Comparisons between early and late AN, and, within the latter, between the 2 different techniques were sought. Statistical analysis was performed for sample description, group comparison and %PRA variation.
  
  
  RESULTS
  Among the 104 patients with a mean age of 47.9 ± 14.2 years, 54 were men. Age, gender, body mass index, and number of previous transplants were similar between early and late AN and between ICAN and ECAN patients. Late AN was associated with less blood loss (293.4 ± 229.0 vs 414.3 ± 349.5 mL; P = .03), shorter hospital stay (12.8 ± 14.5 vs 26.8 ± 26.5; P < .05), and fewer complications (22.2% vs 59.3%; P < .05). The chance of being relisted for transplantation was similar (50.0% in early vs 59.7% in late AN; P = .7). When comparing ICAN and ECAN, there was no difference in surgical outcomes. The %PRA variation between the 2 techniques was comparable (-1.2 ± 10.6 ICAN vs -0.5 ± 15.9 ECAN; P = .8), as was the chance of being relisted for transplantation (60.5% ICAN vs 58.6% ECAN; P = .8).
  
  
  CONCLUSIONS
  Early AN was associated with a greater number of surgical complications. Nevertheless, the number of AN patients returning to the active waiting list was similar between early and late AN groups. ICAN and ECAN had similar surgical and postoperative outcomes, although a bias may be present because some conversions from ECAN to ICAN occurred owing to technical issues. As in other studies, ICAN did not seem to affect allosensitization or jeopardize the chance of being relisted for transplant when compared with ECAN.
authors.affiliation: Urology Department, Instituto Português de Oncologia do Porto, Porto, Portugal. Electronic address: rui.azevedo.freitas@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Freitas
authors.affiliation: Transplantation Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Malheiro
authors.affiliation: Nephrology Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Santos
authors.affiliation: Nephrology Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Costa
authors.affiliation: Transplantation Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: L S
authors.initials: LS
authors.lastname: Martins
authors.affiliation: Transplantation Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Almeida
authors.affiliation: Transplantation Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Dias
authors.affiliation: Transplantation Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Castro-Henriques
authors.affiliation: Nephrology Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Cabrita
authors.affiliation: Transplantation Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Silva-Ramos
authors.affiliation: Transplantation Department, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Almeida
mesh_terms: D064591:Allografts; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011174:Portugal / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*