Transplantectomy: a single-center experiment

Abstract

Introduction: Renal allograft nephrectomy following graft failure carries substantial perioperative morbidity risks. This study aims to comprehensively assess clinical indications, perioperative complications, and patient outcomes related to renal transplantectomy, specifically examining differences between early versus late procedures and urgent versus elective interventions. Methods: A retrospective observational cohort study was conducted, evaluating all renal allograft nephrectomies performed from January 2010 through July 2024 at a tertiary referral center in Portugal. Nephrectomies were classified first as early (≤60 days post-transplant) or late (>60 days post-transplant), then categorized by indication (urgent or elective). Comparisons between early and late allograft nephrectomies in terms of patient characteristics, clinical outcomes, and post-allograft nephrectomy morbidity and mortality were sought. Comparative analyses between urgent and elective nephrectomies were also performed. Results: A total of 112 nephrectomies were performed among 985 kidney transplant recipients, yielding an overall nephrectomy rate of 11.37%. Early nephrectomies (n=57) were predominantly necessitated by venous thrombosis (26.3%), hemorrhagic shock (21.1%), and irreversible acute rejection (21.1%), whereas late nephrectomies (n=55) were mainly driven by chronic rejection (40%) and infections (23.6%). The occurrence of significant perioperative complications was notably higher in the urgent nephrectomy group compared to the elective group (27.3% vs. 4.3%, p=0.002). The overall mortality rate was 2.68%, exclusively observed among patients undergoing urgent nephrectomies. Conclusion: This study highlights the significant impact of timing on clinical outcomes following renal transplantectomy, demonstrating notably higher peri-operatory complications and transfusion rates associated in early and urgent interventions.