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Hashimoto M, Ouchi Y, Yata S, Yamamoto A, Suzuki K, Kobayashi A. The Guidelines for Percutaneous Transhepatic Portal Vein Embolization: English Version. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2024; 9:41-48. [PMID: 38525000 PMCID: PMC10955465 DOI: 10.22575/interventionalradiology.2022-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/26/2023] [Indexed: 03/26/2024]
Abstract
Preoperative portal vein embolization is a beneficial option to reduce the risk of postoperative liver failure by promoting the growth of the future liver remnant. In particular, a percutaneous transhepatic procedure (percutaneous transhepatic portal vein embolization) has been developed as a less-invasive approach. Although percutaneous transhepatic portal vein embolization is widely recognized as a safe procedure, various complications, including rare but fatal adverse events, have been reported. Currently, there are no prospective clinical trials regarding percutaneous transhepatic portal vein embolization procedures and no standard guidelines for the PTPE procedure in Japan. As a result, various methods and various embolic materials are used in each hospital according to each physician's policy. The purpose of these guidelines is to propose appropriate techniques at present and to identify issues that should be addressed in the future for safer and more reliable percutaneous transhepatic portal vein embolization techniques.
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Affiliation(s)
| | - Yasufumi Ouchi
- Department of Radiology, Faculty of Medicine, Tottori University
| | - Shinsaku Yata
- Department of Radiology, Faculty of Medicine, Tottori University
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2
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McDonald M. Allograft nephrectomy vs. no nephrectomy for failed renal transplants. FRONTIERS IN NEPHROLOGY 2023; 3:1169181. [PMID: 37675360 PMCID: PMC10479781 DOI: 10.3389/fneph.2023.1169181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/13/2023] [Indexed: 09/08/2023]
Abstract
The role of allograft nephrectomy (AN) in failed renal transplants is a topic of debate, owing to controversial results reported in the literature and the fact that most of the studies are limited by a retrospective design and small numbers of participants. Allograft nephrectomy is most likely of benefit in the patient with recurrent allograft intolerance syndrome (AIS) following pulse steroids. Immunosuppression weaning in the presence of clinical signs related to a chronic inflammatory state is also reasonable grounds to pursue AN. Studies are mainly inconclusive but suggest that AN has no overall benefit for allograft survival after retransplant. This topic is still of interest in the transplant field and is particularly relevant for patients who are likely to require retransplantation within their lifetime. Further assessment is needed in the form of randomized controlled trials that control for various AN indications and immunosuppression regimens, and have clearly defined survival outcomes.
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Affiliation(s)
- Michelle McDonald
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
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3
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Gunawardena T, Ridgway D. Transplant Nephrectomy: Current Concepts. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:716-725. [PMID: 37955463 DOI: 10.4103/1319-2442.389431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Kidney transplantation is the gold standard treatment option for patients with endstage kidney disease. As the number of waitlisted patients increases, the gap between supply and demand for suitable donor kidneys keeps widening. The adoption of novel strategies that expand the donor pool has attenuated this issue to a certain degree, and this has led to a progressive increase in the number of annual transplants performed. As transplanted kidneys have a finite lifespan, there is a reciprocal rise in the number of patients who return to dialysis once their allograft fails. The clinicians involved in the management of such patients are left with the problem of managing the nonfunctioning allograft. The decision to undertake transplant nephrectomy (TN) in these patients is not straightforward. Allograft nephrectomy is a procedure that is associated with significant morbidity and mortality. It will have implications for the outcomes of the subsequent transplant. In this review, we aimed to compressively discuss the indications, techniques, and outcomes of TN, which is an integral component of the management of a failing allograft.
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Affiliation(s)
- Thilina Gunawardena
- Department of Renal Transplant, Royal Liverpool University Hospital, Liverpool, United Kingdom
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4
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Alhamad T, Lubetzky M, Lentine KL, Edusei E, Parsons R, Pavlakis M, Woodside KJ, Adey D, Blosser CD, Concepcion BP, Friedewald J, Wiseman A, Singh N, Chang SH, Gupta G, Molnar MZ, Basu A, Kraus E, Ong S, Faravardeh A, Tantisattamo E, Riella L, Rice J, Dadhania DM. Kidney recipients with allograft failure, transition of kidney care (KRAFT): A survey of contemporary practices of transplant providers. Am J Transplant 2021; 21:3034-3042. [PMID: 33559315 DOI: 10.1111/ajt.16523] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 01/25/2023]
Abstract
Kidney allograft failure and return to dialysis carry a high risk of morbidity. A practice survey was developed by the AST Kidney Pancreas Community of Practice workgroup and distributed electronically to the AST members. There were 104 respondents who represented 92 kidney transplant centers. Most survey respondents were transplant nephrologists at academic centers. The most common approach to immunosuppression management was to withdraw the antimetabolite first (73%), while only 12% responded they would withdraw calcineurin inhibitor (CNI) first. More than 60% reported that the availability of a living donor is the most important factor in their decision to taper immunosuppression, followed by risk of infection, risk of sensitization, frailty, and side effects of medications. More than half of respondents reported that embolization was either not available or offered to less than 10% as an option for surgical intervention. Majority reported that ≤50% of failed allograft patients were re-listed before dialysis, and less than a quarter of transplant nephrologists performed frequent visits with their patients with failed kidney allograft after they return to dialysis. This survey demonstrates heterogeneity in the care of patients with a failing allograft and the need for more evidence to guide improvements in clinical practice related to transition of care.
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Affiliation(s)
- Tarek Alhamad
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Michelle Lubetzky
- New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York, USA
| | | | - Emmanuel Edusei
- New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York, USA
| | | | - Martha Pavlakis
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Deborah Adey
- University of California San Francisco, San Francisco, California, USA
| | | | | | | | | | - Neeraj Singh
- Willis Knighton Health System, Shreveport, Louisiana, USA
| | - Su-Hsin Chang
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Gaurav Gupta
- Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | | | - Song Ong
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Arman Faravardeh
- SHARP Kidney and Pancreas Transplant Center, San Diego, California, USA
| | | | | | - Jim Rice
- Scripps Heath, San Diego, California, USA
| | - Darshana M Dadhania
- New York Presbyterian Hospital- Weill Cornell Medicine, New York, New York, USA
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5
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Lubetzky M, Tantisattamo E, Molnar MZ, Lentine KL, Basu A, Parsons RF, Woodside KJ, Pavlakis M, Blosser CD, Singh N, Concepcion BP, Adey D, Gupta G, Faravardeh A, Kraus E, Ong S, Riella LV, Friedewald J, Wiseman A, Aala A, Dadhania DM, Alhamad T. The failing kidney allograft: A review and recommendations for the care and management of a complex group of patients. Am J Transplant 2021; 21:2937-2949. [PMID: 34115439 DOI: 10.1111/ajt.16717] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/23/2021] [Accepted: 05/20/2021] [Indexed: 01/25/2023]
Abstract
The return to dialysis after allograft failure is associated with increased morbidity and mortality. This transition is made more complex by the rising numbers of patients who seek repeat transplantation and therefore may have indications for remaining on low levels of immunosuppression, despite the potential increased morbidity. Management strategies vary across providers, driven by limited data on how to transition off immunosuppression as the allograft fails and a paucity of randomized controlled trials to support one approach over another. In this review, we summarize the current data available for management and care of the failing allograft. Additionally, we discuss a suggested plan for immunosuppression weaning based upon the availability of re-transplantation and residual allograft function. We propose a shared-care model in which there is improved coordination between transplant providers and general nephrologists so that immunosuppression management and preparation for renal replacement therapy and/or repeat transplantation can be conducted with the goal of improved outcomes and decreased morbidity in this vulnerable patient group.
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Affiliation(s)
- Michelle Lubetzky
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Ekamol Tantisattamo
- Division of Nephrology, University of California Irvine, Orange, California, USA
| | - Miklos Z Molnar
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, USA
| | - Krista L Lentine
- Internal Medicine-Nephrology, Saint Louis University, St. Louis, Missouri, USA
| | - Arpita Basu
- Division of Transplantation, Emory University, Atlanta, Georgia, USA
| | - Ronald F Parsons
- Division of Transplantation, Emory University, Atlanta, Georgia, USA
| | - Kenneth J Woodside
- Department of Surgery, Section of Transplantation, University of Michigan, Ann Arbor, Michigan, USA
| | - Martha Pavlakis
- Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Christopher D Blosser
- Division of Nephrology, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Neeraj Singh
- Division of Nephrology, Willis Knighton Health System, Shreveport, Louisiana, USA
| | | | - Deborah Adey
- Division of Nephrology, University of California San Francisco, San Francisco, California, USA
| | - Gaurav Gupta
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Arman Faravardeh
- SHARP Kidney and Pancreas Transplant Center, San Diego, California, USA
| | - Edward Kraus
- Department of Medicine, Johns Hopkins, Baltimore, Maryland, USA
| | - Song Ong
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Leonardo V Riella
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Friedewald
- Division of Medicine and Surgery, Northwestern University, Chicago, Illinois, USA
| | - Alex Wiseman
- Division of Nephrology, University of Colorado, Denver, Colorado, USA
| | - Amtul Aala
- Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Darshana M Dadhania
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Tarek Alhamad
- Division of Nephrology, Washington University in St. Louis, St. Louis, Michigan, USA
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6
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Renal artery embolization of non-functioning graft: an effective treatment for graft intolerance syndrome. LA RADIOLOGIA MEDICA 2020; 126:494-497. [PMID: 33047296 DOI: 10.1007/s11547-020-01294-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Percutaneous renal artery embolization is a valid non-invasive technique alternative to nephrectomy for patients with symptomatic non-functioning allograft (graft intolerance syndrome-GIS). The purpose of this article is to report the experience of our centre. METHODS We analysed retrospectively 15 patients with symptomatic non-functioning renal allograft treated with percutaneous embolization from 2003 to 2017. Occlusion was obtained with the injection of calibrated microspheres of increasing size (from 100 to 900 μm) and completed with 5 to 8 mm metal coils placement in the renal artery. RESULTS Technical success was achieved in all cases at the end of the procedure. Clinical success was obtained in 11 patients (73%). In four cases, nephrectomy was necessary: in one case because of septic fever and in three cases because of GIS persistence. In one case, it was possible to perform another procedure to embolize a perirenal collateral from a lumbar artery. Four patients (27%) reported minor complications which spontaneously resolved during the hospital stay. CONCLUSIONS According to the scientific literature, we believe that, in selected patients, percutaneous renal artery embolization is a valid treatment option for GIS thanks to its efficacy, repeatability, minimal invasiveness and the absence of severe complications.
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7
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Garcia-Padilla PK, Afanador D, Gonzalez CG, Yucuma D, Uribe J, Romero A. Renal Graft Embolization as a Treatment for Graft Intolerance Syndrome. Transplant Proc 2020; 52:1187-1191. [PMID: 32173594 DOI: 10.1016/j.transproceed.2020.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Renal graft intolerance syndrome is an inflammatory process that occurs in up to 40% of patients with graft loss. It is characterized by fever, graft pain, hematuria, and anemia. Traditionally, the treatment has been nephrectomy; however, this procedure is associated with high morbidity and mortality rates. As an alternative, graft embolization is associated with success rates of up to 92%. In this study, we describe the graft embolization experience of 1 center, its clinical outcomes and complications. METHODS An observational, retrospective study was conducted. It included all patients with graft intolerance syndrome undergoing graft embolization between 2012 and 2018. The success of the procedure was defined by the resolution of the symptoms that motivated the embolization. RESULTS We found 12 cases of patients undergoing embolization. The time of presentation of the graft intolerance syndrome after admission to dialysis was 6 months (range, 0.6-13). The main clinical manifestation was pain in the area of the graft and macroscopic hematuria. Except for 1 patient, all continued with the immunosuppressive treatment regimen after graft loss for 4 months (range, 0.6-9), received antibiotics for 5.5 days (range, 2-14), and 10 patients received steroid treatment for 6.5 days (range, 5-10). The main complication, secondary to the procedure, was hematoma at the puncture site in 3 patients. Only 1 patient had postembolization syndrome, which resolved with steroid administration. Two patients required postembolization nephrectomy due to persistent renal blood flow and symptoms such as pain and hematuria. The average hospital stay was 5.5 days (range, 1-24). CONCLUSIONS Renal graft embolization is an effective technique as a treatment strategy in patients with clinical signs of intolerance syndrome, with a success rate ≥83.3%, low morbidity, and short hospital stay; furthermore, it avoids the potential complications of a surgical nephrectomy. Graft infection should be ruled out before embolization, and the use of prophylactic antibiotics and steroid therapy is recommended to reduce the risk of postembolization syndrome and infectious complications.
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Affiliation(s)
- Paola Karina Garcia-Padilla
- Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia.
| | - Diana Afanador
- Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia
| | - Camilo Gonzalez Gonzalez
- Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia
| | - Daniela Yucuma
- College of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia
| | - Jorge Uribe
- Department of Radiology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia
| | - Alejandro Romero
- Department of Radiology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia
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8
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Gómez-Dos-Santos V, Lorca-Álvaro J, Hevia-Palacios V, Fernández-Rodríguez AM, Diez-Nicolás V, Álvarez-Rodríguez S, Burgos JB, Guerrero CS, Burgos-Revilla FJ. The Failing Kidney Transplant Allograft. Transplant Nephrectomy: Current State-of-the-Art. Curr Urol Rep 2020; 21:4. [PMID: 31960160 DOI: 10.1007/s11934-020-0957-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review provides a critical literature overview of the risks and benefits of transplantectomy in patients with a failed allograft. Additionally, it offers a summary of related problems, primarily alloantibody sensitization in the event of nephrectomy and immunosuppression weaning. RECENT FINDINGS Transplant nephrectomy has high morbidity and mortality rates. The morbidity of transplant nephrectomy (4.3 to 82%) is mostly due to hemorrhage or infection. Mortality rates range from 1.2 to 39%, and most are due to sepsis. Transvascular graft embolization has been described as a less invasive alternative technique for the management of symptomatic graft rejection, with minimal complications compared with transplantectomy. The number of patients with a failed allograft returning to dialysis is increasing. The role of allograft nephrectomy in the management of asymptomatic transplant failure is still controversial and up today continues to depend on the usual clinical practice of each institution. The less invasive transvascular embolization could have applicability in asymptomatic patients with the obvious lower morbidity and mortality rate.
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Affiliation(s)
- Victoria Gómez-Dos-Santos
- Transplantation and Research Unit, Hospital Ramón y Cajal, Alcalá University, Carretera de Colmenar Km 9.100, 28034, Madrid, Spain.
| | - Javier Lorca-Álvaro
- Urology Department, Hospital Ramón y Cajal, Urology Surgical Research Group and Transplantation, IRYCIS, Alcalá University, Madrid, Spain
| | - Vital Hevia-Palacios
- Urology Department, Urology Surgical Research Group and Transplantation, IRYCIS, Alcalá University, Madrid, Spain
| | | | - Victor Diez-Nicolás
- Urology Department, Urology Surgical Research Group and Transplantation, IRYCIS, Alcalá University, Madrid, Spain
| | - Sara Álvarez-Rodríguez
- Urology Department, Urology Surgical Research Group and Transplantation, IRYCIS, Alcalá University, Madrid, Spain
| | - Jennifer Brasero Burgos
- Urology Department, Hospital Ramón y Cajal, Urology Surgical Research Group and Transplantation, IRYCIS, Alcalá University, Madrid, Spain
| | - Clara Sánchez Guerrero
- Urology Department, Hospital Ramón y Cajal, Urology Surgical Research Group and Transplantation, IRYCIS, Alcalá University, Madrid, Spain
| | - Francisco Javier Burgos-Revilla
- Urology Department, Hospital Ramón y Cajal, Urology Surgical Research Group and Transplantation, IRYCIS, Alcalá University, Madrid, Spain
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9
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Achinger SG, Ayus JC. When the source of inflammation is hiding in plain sight: Failed kidney transplants, clotted arteriovenous grafts, and central venous catheters. Semin Dial 2018; 32:15-21. [PMID: 30032484 DOI: 10.1111/sdi.12739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cardiovascular mortality accounts for most deaths among hemodialysis patients and far exceeds the cardiovascular mortality rate of the general population. One important aspect of cardiovascular risk among dialysis patients is chronic inflammation. Iatrogenic sources of chronic inflammation in the form of failed renal allografts, old clotted arteriovenous grafts, and hemodialysis catheters play important, sometimes, unrecognized roles in this inflammatory state. There is ample observational evidence that these sources of inflammation are associated with hypoalbuminemia, erythropoetin-resistant anemia, and increased markers of chronic inflammation. In dialysis patients with chronic inflammation from potentially modifiable sources, causes should be sought and correction undertaken if possible. Allograft nephrectomy should be offered to patients with a chronic inflammatory state and a failed renal transplant. Unused, clotted AV grafts should be considered a likely source of chronic inflammation as well as infection and should be removed when evidence of infection is present on indium scanning. Catheter rates ought to be kept to a minimum for the many well-recognized reasons for their undesirability as well as for their potential to produce chronic inflammation with all of its ill effects.
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Affiliation(s)
| | - Juan Carlos Ayus
- Renal Consultants of Houston, Houston, TX, USA.,Department of Medicine, Division of Nephrology, University of California, Irvine, CA, USA
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10
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Review: Management of patients with kidney allograft failure. Transplant Rev (Orlando) 2018; 32:178-186. [DOI: 10.1016/j.trre.2018.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/18/2018] [Accepted: 03/21/2018] [Indexed: 12/25/2022]
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11
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Takase HM, Contti MM, Nga HS, Bravin AM, Valiatti MF, El-Dib RP, Modelli de Andrade LG. Nephrectomy Versus Embolization of Non-Functioning Renal Graft: A Systematic Review with a Proportional Meta-Analysis. Ann Transplant 2018. [PMID: 29581414 PMCID: PMC6248024 DOI: 10.12659/aot.907700] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
There is no standardization on the timing of the best approach to treat a non-functioning renal graft. We reviewed the literature and performed a proportional meta-analysis of case series of transplantectomy and embolization for a non-functioning renal graft. The groups were compared for mortality and morbidity outcomes. A total of 2421 patients were included in this review. Of these, 2232 patients underwent transplantectomy and 189 underwent percutaneous embolization. The mortality rate in the nephrectomy group was 4% [95% confidence interval [CI], 2-7%; I²=87%] as compared with 0.1% [95% CI, 0.1-0.5%; I²=0%] in the embolization group. The rates of common morbidities were 18% [95% CI, 13-26%, I²=79.7%] for nephrectomy compared with 1.2% [95% CI, 0.7-2.1%, I²=26.4%] for embolization. The incidence of post-embolization syndrome was 68%, and 20% of patients needed post-embolization nephrectomy. Percutaneous embolization was associated with lower mortality and morbidity rates but also with a high rate of post-embolization syndrome. However, in most cases this complication had easily manageable symptoms. Embolization is a new and attractive technique that can be considered in treating non-functioning renal grafts.
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Affiliation(s)
| | - Mariana Moraes Contti
- Department of Internal Medicine, University of Estadual Paulista, São Paulo, SP, Brazil
| | - Hong Si Nga
- Department of Internal Medicine, University of Estadual Paulista, São Paulo, SP, Brazil
| | - Ariane Moyses Bravin
- Department of Internal Medicine, University of Estadual Paulista, São Paulo, SP, Brazil
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12
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Al Badaai G, Pernin V, Garrigue V, Monnin V, Murez T, Fadli SED, Molinari N, Thuret R, Iborra F, Mourad G. Renal graft intolerance syndrome in late graft failure patients: efficacy and safety of embolization as first-line treatment compared to surgical removal. Transpl Int 2017; 30:484-493. [DOI: 10.1111/tri.12927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/22/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ghalib Al Badaai
- Department of Urology and Renal Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Vincent Pernin
- Department of Nephrology, Dialysis and Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Valérie Garrigue
- Department of Nephrology, Dialysis and Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Valérie Monnin
- Department of Vascular Radiology; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Thibaut Murez
- Department of Urology and Renal Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Saad Ed Dine Fadli
- Department of Urology and Renal Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Nicolas Molinari
- Department of Medical Information; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Rodolphe Thuret
- Department of Urology and Renal Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - François Iborra
- Department of Urology and Renal Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
| | - Georges Mourad
- Department of Nephrology, Dialysis and Transplantation; Montpellier University Hospitals; University of Montpellier Medical School; Montpellier France
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13
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Vora A, Brodsky R, Nolan J, Ram S, Richter L, Yingling C, Venkatesan K, Ghasemian R, Hwang J, Horton K, Verghese M. Incidence of postembolization syndrome after complete renal angioinfarction: a single-institution experience over four years. Scand J Urol 2013; 48:245-51. [PMID: 24215333 DOI: 10.3109/21681805.2013.852620] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Renal angioinfarction (RAI) has been used for various indications in the management of renal tumors. While historically used for palliation of local symptoms (pain or hematuria), this technique has theoretical use in facilitating radical nephrectomy by allowing early ligation of the renal vein, decreasing blood loss and creating edema in resection planes. A common impediment to embolization is the development of postembolization syndrome (PES), which has been reported to have an incidence as high as 89%. This study reports the authors' experience with RAI as a safe palliative and adjunctive procedure over 4 years. MATERIAL AND METHODS From 2008 to 2011, 113 patients underwent complete RAI at Washington Hospital Center for palliative or adjunctive therapy by an interventional radiologist. Procedures were performed in a radiology suite using mild sedation with vascular access obtained by femoral artery puncture. RAI was performed by subsegmental injection of polyvinyl alcohol particles. RESULTS All 113 patients underwent successful RAI with confirmation of total arterial flow ablation via postprocedure arteriogram: 38 underwent embolization for preoperative adjunctive therapy, 34 for palliation of renal mass, 36 for trauma/hemorrhage and five for symptomatic renal artery pseudoaneurysm after partial nephrectomy. PES occurred in 33 out of 75 patients (44.0%), with symptomatic PES in only two patients (2.6%). No major complications (>Clavien grade III) occurred. Thirty-eight patients were excluded from analysis as they underwent radical nephrectomy within 24 h, preventing accurate assessment of PES. CONCLUSIONS RAI is a safe and reliable procedure for palliation of renal masses, as an adjunctive procedure for radical nephrectomy, and for conservative management of renal hemorrhage or aneurysm. PES occurs in relatively few patients, with no major complications, and should not impede clinical consideration of this procedure.
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Affiliation(s)
- Anup Vora
- Departments of Urology, Washington Hospital Center , Washington DC , USA
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14
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Surga N, Viart L, Wetzstein M, Mazouz H, Collon S, Tillou X. Impact of renal graft nephrectomy on second kidney transplant survival. Int Urol Nephrol 2013; 45:87-92. [PMID: 23328966 DOI: 10.1007/s11255-012-0369-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/17/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the impact of non-functional renal graft nephrectomy on second kidney transplantation survival. METHODS We performed a retrospective study on patients managed in our department from April 1989 to April 2011. We compared the number of acute graft rejections and graft survival between patients undergoing second transplantation with (Group I) or without (Group II) prior graft nephrectomy. RESULTS A total of ninety-one patients received a second renal graft: 43 underwent graft nephrectomy and 48 kept their non-functional renal graft. There were 5 episodes of acute graft rejection in Group I and 12 in Group II (p = 0.3). Six (13.9 %) grafts failed in Group I and eight (16.6 %) in Group II. Five and 10 years actuarial graft survival in Group I were, respectively, 91 and 85 %, while in Group II were 82.7 % and 69 % (p = 0.2). PRA level and number of acute rejection episodes did not have a statistically significant influence on graft survival, whether the patient had a nephrectomy or not (p = 0.2). CONCLUSION Nephrectomy of a failed allograft did not significantly improve the survival of a subsequent graft. Graft nephrectomy should be indicated in case of graft-related pain or a chronic inflammation syndrome.
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Affiliation(s)
- Nicolas Surga
- Department of Urology and Transplantation, University Hospital of Amiens, Amiens, France
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Pérez Rodríguez MT, Sopeña B, Lueiro F, Martínez-Vázquez C. Late infection of an embolized renal graft presented as buttock cellulitis. Transpl Infect Dis 2009; 12:161-3. [PMID: 19891755 DOI: 10.1111/j.1399-3062.2009.00467.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Graft intolerance syndrome (GIS) is a common complication developed in failed kidney allografts left in situ when the patients returned to hemodialysis. GIS usually develops within the first 6 months after immunosuppression has been withdrawn. When medical treatment has failed, transplantectomy is the conventional therapy. Nevertheless, in recent years, transvascular ethanol embolization has been reported as an effective, safe, and less invasive technique than transplantectomy for the management of patients with GIS. Although infrequent, the most severe complication is infection of the graft or surrounding tissues, which usually appears in the first weeks after the procedure. We present the first case of late infection of an embolized renal graft, more than 2 years after embolization.
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Affiliation(s)
- M T Pérez Rodríguez
- Internal Medicine Department, Hospital Universitario Xeral-Cíes of Vigo, Pontevedra, Spain
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Morales A, Gavela E, Kanter J, Beltrán S, Sancho A, Escudero V, Crespo J, Pallardó LM. Treatment of renal transplant failure. Transplant Proc 2008; 40:2909-11. [PMID: 19010144 DOI: 10.1016/j.transproceed.2008.09.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Among graft failures beyond months, we performed progressive reduction and complete withdrawal of immunosuppressive drugs and steroids over a period of 6 months. PATIENTS AND METHODS We analyzed the treatment and complications associated with all late allograft failures in 34 patients (8.19%) out of 415 patients transplanted from November 1996 to November 2006. RESULTS In 21 patients (61.8%), the progressive reduction of immunosuppressive treatment was effective and well tolerated; however, in 13 patients (38.2%) there was rejection of the allograft at 10.74 +/- 8.95 months (0.77-34.80) after the failure. With the reintroduction of these drugs, the rejection was controlled in seven patients, but in the other six we had to embolize the allograft, which had to be repeated in one case. Embolization was well tolerated, but in one case there was migration of one coil to the femoral artery. One patient treated with drug withdrawal experienced emphysematous pyelonephritis after repeated urinary infections, requiring a nephrectomy. Thirteen (38.2%) of the patients with late failures have been admitted for a second transplant; five of them showed HLA sensitization. CONCLUSIONS Conservative treatment with progressive withdrawal of immunosuppression was effective and well tolerated in two-thirds of the patients with late renal allograft failure, but one-third of the patients rejected the graft and needed allograft embolization. Infection of the graft and HLA sensitization can complicate the course of these patients.
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Affiliation(s)
- A Morales
- Service de Nefrología, Hospital Universitario Dr Peset, Valencia, Spain.
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17
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Neschis DG, Gutta R, Al-Qudah HS, Bartlett ST, Philosophe B, Schweitzer EJ, Flinn WR, Campos L. Intraoperative coil embolization reduces transplant nephrectomy transfusion requirement. Vasc Endovascular Surg 2007; 41:335-8. [PMID: 17704337 DOI: 10.1177/1538574407302845] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transplant nephrectomy for failed renal transplants can be challenging. Patients often have numerous comorbidities, and the procedure may be associated with considerable blood loss. This study was performed to determine if intraoperative coil embolization of the transplant renal artery reduces blood loss associated with transplant nephrectomy. Data were collected retrospectively on 13 consecutive transplant nephrectomies performed immediately following coil embolization and compared with the 13 most recently performed consecutive transplant nephrectomies without coil embolization. The groups were compared for operative time, estimated blood loss, and transfusion requirements. Mean age was 45 in both groups. There were no major complications in either group. Operative times were not significantly different, although open operative time was reduced in the embolization group (113 vs 96 minutes). Estimated blood loss was 465 mL versus 198 mL (P = .035); packed red blood cell requirements during the operation and subsequent 48 hours were 1.85 units versus 0.31 units (P = .008) and during the operation and subsequent hospital stay were 2.3 units versus 0.69 units (P = .027) in the nonembolized group and embolized group, respectively. Intraoperative embolization of the transplant renal artery immediately prior to surgery facilitates transplant nephrectomy by significantly reducing intraoperative blood loss and transfusion requirements while slightly reducing open operative time.
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Affiliation(s)
- David G Neschis
- Divisions of Vascular Surgery, University of Maryland Medical Cebter, Baltimore, Maryland 21201, USA. dneschis @smail.umaryland.edu
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Capozza N, Collura G, Falappa P, Caione P. Renal embolization as an alternative to surgical nephrectomy in children. Transplant Proc 2007; 39:1782-4. [PMID: 17692611 DOI: 10.1016/j.transproceed.2007.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Complete renal embolization may be an alternative to surgical nephrectomy. The indications for renal embolization do not differ from those for surgical nephrectomy, but the less invasive nature of the technique is a major advantage. Few case reports are available in the pediatric age group. Our experience showed that complete renal embolization was feasible in pediatric patients with results comparable to those obtained in adults. MATERIALS AND METHODS Twelve pediatric patients underwent 14 renal embolizations. The indications for embolization were as follows: (1) severe hypertension in 7 patients with end-stage renal failure; in these cases, a unilateral native nephrectomy was recommended prior to renal transplantation; (2) end-stage hydronephrosis in 3 patients with moderate hypertension or recurrent urinary infection; (3) nephrotic syndrome in 1 patient; or (4) ablation of an irreversibly rejected renal allograft in 1 patient. The embolization was performed under epidural anesthesia in 10 patients and under general anesthesia in 2 patients, by means of a polyvinyl alcohol injection with hemostatic gelatin powder and placement of coils. Postembolization course was followed. RESULTS The embolization was successful in all 12 patients. In 1 patient, the procedure had to be repeated as a small accessory artery had revascularized the upper pole. In another patient, the procedure was bilateral in 2 separate sessions. In 10 patients, severe flank pain required narcotic analgesia. Two patients had fever. None had hypertension peaks. Median hospital stay was 4 days. At mean follow-up of 16 months, the results were stable. CONCLUSION Renal embolization can avoid surgical nephrectomy also in pediatric patients. The advantages are less morbidity and shorter hospital stay. Our results in the short and medium term were equal to those of surgical removal. The procedure appeared to be safe and minimally invasive.
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Affiliation(s)
- N Capozza
- Renal Transplantation Unit, Department Nephrology-Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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20
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Ortín-Pérez J, Fuster D, Lomeña F, Torregrosa JV, Piera C, Rodríguez-Puig D, Duch J, Rubí S, Setoain X, Campistol JM, Pons F. Utilidad de la gammagrafía con plaquetas marcadas con 111In-oxina en el manejo del síndrome febril en pacientes en diálisis portadores de injerto renal no funcionante. ACTA ACUST UNITED AC 2006; 25:289-93. [PMID: 17173774 DOI: 10.1157/13092695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM To evaluate the usefulness of 111In-oxine-labelled platelet scan in the therapeutic management of prolonged febrile syndrome in dialysis patients with a non-functional renal allograft. MATERIAL AND METHODS One hundred and fifty-eight patients (94 men, 64 women; mean age 44 +/- 9 years) were studied. Duration of fever was 42 days (range 7-112). A total of 68 % of the patients (107/158) were on low doses of corticosteroids (<10 mg/day). Platelet scans were performed 48 hours after reinjection of 111In-ixone-labelled platelets. A platelet uptake index (PUI) was calculated by dividing the cpm/pixel in the allograft by the cpm/pixel in a mirror background. A PUI > or = 1.5 was considered as threshold for immunological fever. The final diagnosis of immunological fever was established when it disappeared after transplantectomy, embolization or high doses of corticosteroid therapy. Fever of non-immunological origin was established when it disappeared after antibiotic therapy. RESULTS In 102/158 patients the fever was considered of immunological origin. In 56/158 patients the fever was considered of non immunological origin. Sensitivity and the specificity of the platelet scan was 80 % and 100 %, respectively. All those patients considered as having fever of immunological origin who had PUI <1.5 had been using corticosteroids during platelet scan. CONCLUSION 111In-labelled platelet scintigraphy is a useful technique in the therapeutic management of prolonged febrile syndrome in dialysis patients with non-functional renal allograft. The use of corticosteroids can reduce the sensitivity of 111In- labelled platelet scan.
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Affiliation(s)
- J Ortín-Pérez
- Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, España
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Delgado P, Diaz F, Gonzalez A, Sanchez E, Gutierrez P, Hernandez D, Torres A, Lorenzo V. Intolerance syndrome in failed renal allografts: incidence and efficacy of percutaneous embolization. Am J Kidney Dis 2005; 46:339-44. [PMID: 16112054 DOI: 10.1053/j.ajkd.2005.04.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Accepted: 04/11/2005] [Indexed: 11/11/2022]
Abstract
BACKGROUND Immunologic intolerance to a failed renal allograft left in situ is referred to as graft intolerance syndrome, the incidence and predictors of which are unknown. Treatment by transcatheter vascular embolization has been reported to be less invasive than transplantectomy. The incidence of graft intolerance syndrome and results of transcatheter vascular embolization as a first therapeutic approach were studied. METHODS A retrospective study of 149 transplant recipients who returned to dialysis therapy between June 1989 and December 2001 was performed. After immunosuppression withdrawal, a diagnosis of graft intolerance syndrome was made based on clinical criteria and confirmed by the persistence of renal perfusion under imaging procedures. Potential immunologic predictors were analyzed. RESULTS Of 149 patients with failed renal allografts, 55 patients (37%) developed graft intolerance syndrome during follow-up (27.5 +/- 34.5 months; range, 1 to 173 months). Manifestations of graft intolerance syndrome were fever (88%), flu-like symptoms (33%), hematuria (39%), local pain (53%), and increased graft size (51%). Most episodes of graft intolerance syndrome appeared within 6 months (virtually all presented within 24 months after graft failure). None of the immunologic variables studied showed an influence on graft intolerance syndrome. Transcatheter vascular embolization was performed in 48 patients and was successful in 31 patients (65%). A second embolization was necessary in 8 patients. No deaths or severe complications were observed. Eleven patients (22%) underwent transplantectomy because of persistent graft intolerance syndrome (n = 8) or graft infection (n = 3). CONCLUSION Graft intolerance syndrome is common in patients with failed renal allografts left in situ, especially within the first year of returning to dialysis therapy. Our data support transcatheter vascular embolization as first-line therapy for patients with symptomatic failed renal allografts, although 1 in 4 patients will require transplantectomy.
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22
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Capocasale E, Larini P, Mazzoni MP, Marcato C, Dalla Valle R, Busi N, Monaco D, Benozzi L, Sianesi M. Percutaneous Renal Artery Embolization of Nonfunctioning Allograft: Preliminary Experience. Transplant Proc 2005; 37:2523-4. [PMID: 16182732 DOI: 10.1016/j.transproceed.2005.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Percutaneous renal artery embolization has been introduced as an alternative to nephrectomy for patients with a nonfunctioning allograft and Graft Intolerance Syndrome. The symptoms resulting from this syndrome include fever, local pain, hypertension, and hematuria. From April 2003 to October 2003, 5 patients were treated with this technique. The intraparenchymal renal arteries were embolized by injection of calibrated tris-acryl gelatin microspheres of increasing size (from 100-330 to 700-900 microm) and completed with the insertion of 5-mm-8-mm steel coils in the renal artery. The procedure was well tolerated in all cases; no major complications occurred. In 3 patients, the symptoms disappeared immediately. In 1 patient, it was necessary to perform a second embolization due to collateral circulation developing from a lumbar artery; this further procedure resolved the symptoms. In the last case, the patient underwent nephrectomy because of septic fever. In conclusion, patients with this syndrome refractory to medical treatment may be treated by the effective and minimally invasive procedures of percutaneous allograft artery embolization with no significant short-term or late complications.
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Affiliation(s)
- E Capocasale
- Department of Surgery, Institute of General Surgery and Organ Transplantation, University of Parma, Italy
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23
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Abstract
Recently it has been shown that patients returning to hemodialysis (HD) following kidney transplant loss have poor survival, though the factors responsible for these poor outcomes remain largely unknown. In the past, we have shown that occult infection of clotted arteriovenous grafts (AVGs) leads to a chronic inflammatory state characterized by erythropoietin resistance, hypoalbuminemia, elevated C-reactive protein (CRP), and poor outcomes. It is well known that failed renal allografts induce graft intolerance syndrome, a clinical syndrome of pain, fever, and anemia, in the majority of patients. Similarly we have shown that failed renal allografts, by their nature as a nidus of chronic immunoreactivity, also induce a chronic inflammatory state. We speculate that this chronic inflammatory state, characterized by biochemical markers of poor HD outcomes, may be responsible for the excess mortality in this group. It is currently standard practice to leave failed kidney transplants in place upon return to HD and to treat symptomatic graft intolerance syndrome with immunosuppression. While this approach may reduce clinical symptoms in the short term, treatment failure and ultimately transplant nephrectomy occur in the majority of cases. There is also evidence that continued immunosuppression can even be dangerous. It should be noted that medical treatment of graft intolerance syndrome has not been shown to reduce chronic inflammation or decrease mortality. Similarly embolization of failed kidney transplants, another option for handling failed kidney transplants, has a high rate of treatment failure, has not been shown to reduce chronic inflammation, and nothing is known about the long-term safety of this approach. Therefore failed kidney transplants in patients with biochemical markers of chronic inflammation (as is the case for infected, clotted AVGs) should be removed prior to the development of clinical symptoms in order to eliminate the chronic inflammatory state.
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González-Satué C, Riera L, Franco E, Castelao A, Sancho C, Ponce A, Serrallach N. [Percutaneous embolization of non-functioning renal graft as therapeutic alternative to surgical transplantectomy]. Actas Urol Esp 2004; 24:319-24. [PMID: 14964090 DOI: 10.1016/s0210-4806(00)72455-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To analyze the indications, results and complications of embolisation of a non-tolerated, non-functioning renal graft with regards to surgical transplantectomy. MATERIAL AND METHODS Between 1990 and 1998, 55 patients with failed renal graft were studied. Patients had undergone either subcapsular transplantectomy (23 patients) or percutaneous embolisation of allograft (32 patients). Mean age in both groups was 40.9 +/- 3.14 and 42 +/- 2.45 years respectively. After start of dialysis, the graft was left in situ for an average of 10.2 (+/- 11.2) and 9.9 (+/- 6.5) months. Hospital stay, occurrence of complications from the technique used, and results were compared. RESULTS Post-embolisation syndrome (high temperature for 2 to 5 days) was seen in 59% cases. No major complications secondary to embolization were seen, whereas 13% subcapsular nephrectomies had complications that required re-operation. Hospital stay was shorter (p > 0.005) in embolized patients than in those undergoing surgery. Sings and symptoms of intolerance disappears in 84.4% embolizations. Results were unsuccessful in 5 grafts (15.6%) undergoing embolisation, which resulted in deferred subcapsular transplantectomy. CONCLUSIONS Long-term, embolization shows acceptable control over the signs and symptoms of intolerance and involves less morbidity than transplantectomy. Surgery is useful when intolerance persists after one or more embolizations. Because of its features of safety and effectiveness, embolisation should be a choice treatment in selected cases.
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Affiliation(s)
- C González-Satué
- Servicio de Urología, Ciudad Universitaria y Sanitaria de Bellvitge, L'Hospitalet de Llobregat, Barcelona
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Delgado P, Diaz F, Gonzalez A, Hernández E, Hidalgo R, Hernández D, Gutierrez P, Lorenzo V. Transvascular ethanol embolization: first option for the management of symptomatic nonfunctioning renal allografts left in situ. Transplant Proc 2003; 35:1684-5. [PMID: 12962757 DOI: 10.1016/s0041-1345(03)00624-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Transplantectomy has been the conventional therapy for symptomatic failed grafts left in situ (FGLIS). Graft intolerance syndrome (GIS) is a common complication after withdrawal of immunosuppression. Our group first reported transvascular ethanol embolization (TVEE) as an alternative for the management of GIS. OBJECTIVE Our goal was to evaluate the efficacy and safety of TVEE in a large series of patients with symptomatic FGLIS. PATIENTS AND METHODS From January 1989 to December 2001, 944 patients received cadaveric renal transplants in our center. During this period, 59 patients with FGLIS underwent TVEE (50+/-7 years, 71% men, 15% diabetics). TVEE was performed using a transfemoral approach. A balloon occlusion catheter was inflated in the renal artery before ethanol injection (10-12 cc). The position of coils completed the procedure. No systematic prophylactic antibiotic or steroid treatment was administered. RESULTS The main indication for TVEE was GIS (51 patients, 86%). TVEE was initially successful in 39 patients (66%). A second TVEE, which was performed in 9 of 20 unresolved cases, was successful in six. After a second TVEE, the efficacy increased to 76%. The most frequent complication was postembolization syndrome (62%), which was manifested by fever, local pain, and inflammation that generally resolved in 48-72 hours. No major complications or deaths were observed. One of four patients underwent transplantectomy. Histologic examination of the removed graft showed renal tissue necrosis (10 cases) and pyonephrosis (4 cases). CONCLUSIONS TVEE, a safe and effective technique, may be considered as the treatment of choice for symptomatic FGLIS.
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Affiliation(s)
- P Delgado
- Nephrology Service, University Hospital of Canary Islands, Tenerife, Spain
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Cofan F, Real MI, Vilardell J, Montanya X, Blasco J, Martin P, Oppenheimer F, Gutierrez R, Talbot-Wright R, Alcover J. Percutaneous renal artery embolisation of non-functioning renal allografts with clinical intolerance. Transpl Int 2002. [DOI: 10.1111/j.1432-2277.2002.tb00145.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marco Pérez LM, Riera Canals L, Romera Villegas A, Iborra E, González Satué C, Trilla Herrera E, Franco Miranda E, Serrallach Mila N. [Iliac pseudoaneurysm in non-functioning renal graft 10 years after embolization]. Actas Urol Esp 2001; 25:683-5. [PMID: 11765557 DOI: 10.1016/s0210-4806(01)72699-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The arterial pseudoaneurysms are an infrequent complication or renal transplantation. Depending on her localization, are divided in intra and extrarenal. The first are relacionated with the practice of percutaneous needly biopsy. The seconds are associated with defects of vascular anastomose or infection onsurgical area (with relative precocious presentation). Presentation of case of a iliac pseudoaneurysm in non-functional kidney allograft embolizated ten years before. This pathology, for this clinic gravity, requires urgent surgical treatment.
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Affiliation(s)
- L M Marco Pérez
- Servicio de Urología, Ciutat Sanitaria i Universitaria de Bellvitge, L'Hospitalet de Llobregat, Barcelona
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Sebastià C, Quiroga S, Boyé R, Cantarell C, Fernandez-Planas M, Alvarez A. Helical CT in renal transplantation: normal findings and early and late complications. Radiographics 2001; 21:1103-17. [PMID: 11553819 DOI: 10.1148/radiographics.21.5.g01se131103] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Over a 5-year period, 346 helical computed tomographic (CT) studies were performed in renal transplant recipients. Helical CT proved useful in this context by depicting parenchymal, perirenal, renal sinus, pyeloureteral, and vascular complications in great detail. CT often delineates fluid collections and their anatomic relationship to adjacent structures better than ultrasonography (US), particularly in obese patients. CT-guided puncture and drainage can be performed in cases in which US is deemed inadequate. CT angiography can depict arterial diseases such as stenosis, thrombosis, arteriovenous fistulas, aneurysms, and pseudoaneurysms in the graft artery and in the recipient iliac arterial system, thereby obviating conventional angiography in some cases. Helical CT with three-dimensional image reformatting allows accurate imaging of the entire course of ureteral and periureteral diseases (eg, hydronephrosis, ureteral leak and stricture, pyeloureteral obstruction). CT can be used in the confirmation and staging of malignancies of the renal parenchyma and urothelium. It is also helpful in evaluating associated disease in the native kidneys, acute and chronic rejection, graft embolization, and end-stage disease. Although US and nuclear medicine examination are the imaging modalities of choice in renal transplantation, helical CT is a valuable alternative when these techniques are inconclusive.
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Affiliation(s)
- C Sebastià
- Institute for Diagnostic Imaging, Hospital General Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain.
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González-Satué C, Riera L, Franco E, Escalante E, Dominguez J, Serrallach N. Percutaneous embolization of the failed renal allograft in patients with graft intolerance syndrome. BJU Int 2000; 86:610-2. [PMID: 11069363 DOI: 10.1046/j.1464-410x.2000.00881.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyse the circumstances, results and complications of percutaneous embolization in failed renal grafts that are not tolerated, to avoid surgical graft removal in selected patients. PATIENTS AND METHODS The study included 33 patients (mean age 42 years, SD 13.9) whose renal grafts failed between 1990 and 1999. The patients underwent percutaneous embolization of their renal transplant for graft intolerance syndrome. The allograft was left in situ after failure for a mean (SD) of 9.9 (6.5) months. The subsequent hospital stay, the appearance of complications and the final results were assessed. RESULTS Post-embolization syndrome (fever for 2-5 days) appeared in 20 (61%) of the patients; the clinical intolerance resolved in 28 (85%). The embolization was unsuccessful in five of the 33 patients (15%) and they required graft removal. The mean (SD) hospital stay was 5 (2) days; there were no major complications from graft embolization. CONCLUSIONS Graft embolization avoids kidney removal in many patients with failed and rejected transplants, with low rates of morbidity. Surgical graft nephrectomy was useful when graft intolerance syndrome persisted after embolization.
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Affiliation(s)
- C González-Satué
- Service of Urology and Radiology, Ciutat Sanitaria i Universitaria de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain.
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Cofán F, Vilardell J, Gutierrez R, Real M, Montanya X, Oppenheimer F, Talbot-Wright R, Carretero P. Efficacy of renal vascular embolization versus surgical nephrectomy in the treatment of nonfunctioning renal allografts. Transplant Proc 1999; 31:2244-5. [PMID: 10500560 DOI: 10.1016/s0041-1345(99)00321-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F Cofán
- Renal Transplant Unit, Hospital Clinic, Barcelona, Spain
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32
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Fan CM, Poplausky MR. Transcatheter renal artery embolization: Indications and technical considerations. Tech Vasc Interv Radiol 1999. [DOI: 10.1016/s1089-2516(99)80053-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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HOM DAVID, EILEY DAVID, LUMERMAN JEFFREYH, SIEGEL DAVIDN, GOLDFISCHER EVANR, SMITH ARTHURD. COMPLETE RENAL EMBOLIZATION AS AN ALTERNATIVE TO NEPHRECTOMY. J Urol 1999. [DOI: 10.1016/s0022-5347(01)62049-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- DAVID HOM
- Departments of Urology and Radiology, Long Island Jewish Medical Center, New Hyde Park, New York
| | - DAVID EILEY
- Departments of Urology and Radiology, Long Island Jewish Medical Center, New Hyde Park, New York
| | - JEFFREY H. LUMERMAN
- Departments of Urology and Radiology, Long Island Jewish Medical Center, New Hyde Park, New York
| | - DAVID N. SIEGEL
- Departments of Urology and Radiology, Long Island Jewish Medical Center, New Hyde Park, New York
| | - EVAN R. GOLDFISCHER
- Departments of Urology and Radiology, Long Island Jewish Medical Center, New Hyde Park, New York
| | - ARTHUR D. SMITH
- Departments of Urology and Radiology, Long Island Jewish Medical Center, New Hyde Park, New York
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Reilly KJ, Shapiro MB, Haskal ZJ. Angiographic embolization of a penetrating traumatic renal arteriovenous fistula. THE JOURNAL OF TRAUMA 1996; 41:763-5. [PMID: 8858045 DOI: 10.1097/00005373-199610000-00031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- K J Reilly
- Division of Traumatology and Surgical Critical Care, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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