Guidelines For Clinical Practice
Copyright ©2011 Baishideng Publishing Group Co.
World J Transplant. Dec 24, 2011; 1(1): 4-12
Published online Dec 24, 2011. doi: 10.5500/wjt.v1.i1.4
Table 1 Indications for transplant nephrectomy
Cause of failureRenal vein thrombosisTransplant pyonephrosis
Renal artery occlusion
Acute rejection refractory to treatment[17]
Allograft associated complicationsPrimary non functionApart from tumors, these occur in the early phase after transplantation
Bleeding post biopsy[17]
Transplant rupture[18]
Rupture of pseudoaneurysm
Malignant tumors[18]
Following failurePain due to uncontrolled rejection[5]
Graft tenderness[14]
Anemia resistant to treatment
Recurrent urinary tract infection
Persistent hematuria
MiscellaneousPreliminary measure prior to re-transplantation[19]For example, failed kidney-pancreas transplant awaiting combined re-transplantation
Recurrence of primary disease
Polyoma virus nephropathy
Table 2 Techniques of transplant nephrectomy
Description of technique[43]Dissection outside kidney capsule to remove kidney including capsule, ureter and most of the transplant vesselsDissection within kidney capsule which is densely ardent to surrounding tissues by the time of late graft removal
Mean procedure time[35]125.3 min109.4 min
Blood loss[35]385 (60-1500) mL638 (70-2200) mL
Blood transfusion[35]6/17 (35.3%)16/30 (53.3%)
Complication rate[35]3/17 (17.6%)6/30 (20%)
CommentsSuitable for early graft failuresGenerally used for late graft failures
Table 3 Complications of transplant nephrectomy
HemorrhageCommonest problem
Infection: superficial deepExtremely high in earlier series[39]
Pseudoaneurysm of iliac vesselsTreat by endovascular techniques
Urinary fistula
Bowel injury
Injury to obturator nerve or lateral cutaneous nerve of the thighUncommon
Table 4 Effect of transplant nephrectomy on subsequent transplant function
StudyTNNoPRA (%) > 30%HLA (mm)Delayed graft function (%)Acute rejection (%)Graft survival (%)
1 yr5 yr
Sumrani et al[14], 1992Yes  355763AR rates similar between groups
No  523330
Yagmurdur et al[16], 2005Yes  211.9 ± 1.1438345Retrospective
No  321.0 ± 0.6386968TN has no advantage
Johnston et al[10], 2007Yes  621314.764.8%133.6USRDS 1995-2003
No12 89412.653.4%124.4Early TN associated with lower risk of transplant failure
Ahmad et al[15], 2009Yes  6837249.183.866.2PRA level significantly influences graft survival independent of TN
No  2129231.294.769.5
Schleicher et al[19], 2011Yes  121162.2 ± 1.529.329.7Retrospective study
No  4522.0 ± 1.72013.3Graft survival worse in TN group