title: Use of preoperative embolization prior to Transplant nephrectomy.
abstract: BACKGROUND
  After a failed transplant, management of a non-functional graft with pain or recurrent infections can be challenging. Transplant nephrectomy (TN) can be a morbid procedure with the potential for significant blood loss. Embolization of the renal artery alone has been proposed as a method of reducing complications from an in vivo failed kidney transplant. While this does yield less morbidity, it may not address an infected graft or refractory hematuria or rejection. We elected to begin preoperative embolization to assess if this would help decrease the blood loss and transfusion rate associated with TN.
  
  
  METHODS
  We performed a retrospective analysis of all patients who underwent non-emergent TN at our institution. Patients who had functioning grafts that later failed were included in analysis. TN was performed for recurrent infections, pain or hematuria. We evaluated for blood loss (EBL) during TN, transfusion rate and length of hospital stay.
  
  
  RESULTS
  A total of 16 patients were identified. Nine had preoperative embolization or no blood flow to the graft prior to TN. The remaining 7 did not have preoperative embolization. The shortest time from transplant to TN was 8 months and the longest 18 years with an average of 6.3 years. Average EBL for the embolized patients (ETN) was 143.9cc compared to 621.4cc in the non-embolized (NETN) group (p=0.041). Average number of units of blood transfused was 0.44 in the ETN with only 3/9 patients requiring transfusion. The NETN patients had average of 1.29 units transfused with 5/7 requiring transfusion. The length of stay was longer for the ETN (5.4 days) compared to 3.9 in the NETN. No intraoperative complications were seen in either group and only one patient had a postoperative ileus in the NETN.
  
  
  CONCLUSIONS
  Embolization prior to TN significantly decreases the EBL but does not significantly decrease transfusion rate. However, patients do require a significantly longer hospitalization with embolization due to the time needed for embolization. Larger studies are needed to determine if embolization before transplant nephrectomy reduces the transfusion rates and overall complications.
authors.affiliation: Department of Urology, University of Missouri, Missouri, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Yeast
authors.affiliation: UNM - Surgery Albuquerque, New Mexico, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Riley
authors.affiliation: Department of Urology, University of Missouri, Missouri, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Holyoak
authors.affiliation: Department of Urology, University of Missouri, Missouri, USA.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Ross
authors.affiliation: Department of Urology, University of Missouri, Missouri, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Weinstein
authors.affiliation: Department of Urology, University of Missouri, Missouri, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Wakefield
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D011300:Preoperative Care; D057234:Preoperative Period; D012077:Renal Artery; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult