Guidelines For Clinical Practice
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Transplant. Dec 24, 2011; 1(1): 4-12
Published online Dec 24, 2011. doi: 10.5500/wjt.v1.i1.4
Transplant nephrectomy
Jacob A Akoh
Jacob A Akoh, South West Transplant Centre, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom
Author contributions: Akoh JA solely contributed to this paper.
Correspondence to: Jacob A Akoh, FRCSEd, FRCS (Gen), Consultant General and Transplant Surgeon, South West Transplant Centre, Plymouth Hospitals NHS Trust, Level 04, Derriford Hospital, Plymouth PL6 8DH, United Kingdom.
Telephone: +44-1752-439798 Fax: +44-1752-774651
Received: July 14, 2011
Revised: October 17, 2011
Accepted: December 19, 2011
Published online: December 24, 2011

About 10% of all renal allografts fail during the first year of transplantation and thereafter approximately 3%-5% yearly. Given that approximately 69 400 renal transplants are performed worldwide annually, the number of patients returning to dialysis following allograft failure is increasing. A failed transplant kidney, whether maintained by low dose immunosuppression or not, elicits an inflammatory response and is associated with increased morbidity and mortality. The risk for transplant nephrectomy (TN) is increased in patients who experienced multiple acute rejections prior to graft failure, develop chronic graft intolerance, sepsis, vascular complications and early graft failure. TN for late graft failure is associated with greater morbidity and mortality, bleeding being the leading cause of morbidity and infection the main cause of mortality. TN appears to be beneficial for survival on dialysis but detrimental to the outcome of subsequent transplantation by virtue of increased level of antibodies to mismatched antigens, increased rate of primary non function and delayed graft function. Many of the studies are characterized by a retrospective and univariate analysis of small numbers of patients. The lack of randomization in many studies introduced a selection bias and conclusions drawn from such studies should be applied with caution. Pending a randomised controlled trial on the role of TN in the management of transplant failure patients, it is prudent to remove failed symptomatic allografts and all grafts failing within 3 mo of transplantation, monitor inflammatory markers in patients with retained failed allografts and remove the allograft in the event of a significant increase in levels.

Keywords: Allograft intolerance syndrome, Hemorrhage, Immunosuppression, Infection, Panel reactive antibody, Patient survival, Subsequent graft survival