An interesting article would like to share with you:
Transplant Nephrectomy Improves Survival following a Failed Renal Allograft , Juan Carlos Ayus et al. J Am Soc Nephrol 21: 374–380, 2010.
There are a growing number of patients returning to dialysis after a failed kidney transplant; the prevalence and incidence of ESRD are projected to increase substantially in the US during the next several decades. Approximately 2000 patients annually enter dialysis in the United States after allograft failure (10% of the population initiating dialysis) and only approximately 15% undergo repeat transplantation. Thus, optimal treatment of the large majority of these patients who do not receive repeat kidney transplantation is a challenging problem risk for death after renal allograft failure is an underappreciated problem.
This study is a large, retrospective cohort of patients returning to dialysis after failed kidney transplant. It shows close to 32% decrease in relative risk of death from any reason in those patients who had allograft nephrectomy after starting on dialysis.
Theories mentioned in previous literature explaining why keeping the allograft in situ increase death are:
1-The presence of a failed allograft at dialysis initiation is associated with anemia and hypoalbuminemia—predictors of poor outcomes among dialysis patients.
2-Chronically rejected renal allograft is a nidus of immunoreactivity that causes chronic inflammation-a major CVD risk.
3-Continued use of Immunosuppressants which has increase risk – CVD/infections.
So why don’t we perform allograft nephrectomy for all failed allograft as standard of care for all patients retaining to dialysis?
It’s shown in previous studies that allograft nephrectomy has a negative impact on the Percent Panel Reactive Antibodies, with a significant rise in the PRA post nephrecotmy persistently, which can theoretically decrease the chance of having a matching donor if future transplant is considered!
Also, not to ignore the fact that these patients are high risk; and allograft nephrectomy carries high morbidity and mortality rate which can go up into 20-30% of cases.
Overall, allograft nephrectomy should always be considered, especially for those who can tolerate the surgery and have no future plan for a repeated transplant. We still need prospective randomized controlled trials regarding this issue and its’ affect on the PRA.
- ► 2021 (36)
- ► 2020 (32)
- ► 2019 (42)
- ► 2018 (57)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- ► 2011 (370)
- CLINICAL CASE 9
- The Online Transplant Center: Post transplant MPGN
- Post transplant MPGN
- TOPIC DISCUSSION: PCO2, which one is better?
- Image Quiz- Answers
- CONSULT ROUNDS: METHANOL and the EYE?
- CONSULT ROUNDS: ACID BASE
- JOURNAL CLUB: Kidney allograft nephrectomy can imp...
- TOPIC DISCUSSION: Nutrition
- TOPIC DISCUSSION: Drugs and Cyclosporine
- IN THE NEWS- NSF and Kidney Transplantation
- Bowel Transplantations, not enough!
- Horseshoe Kidney
- The Online Transplant Center: New Agents for renal...
- CLINICAL CASE 8
- History of Nephrology: The first randomised contro...
- Common Sense vs. Evidence-based Medicine
- TOPIC DISCUSSION: DIFFERENT TYPES OF PROTEINURIA
- New Agents for renal transplantation
- TOPIC DISCUSSION: Renal Artery Stenosis
- TOPIC DISCUSSION: THE WWW and the NEPHROLOGIST
- IN THE NEWS- Hyperkalemia treatment in trouble
- IN THE NEWS ---> ACUTE KIDNEY INJURY
- CONSULT ROUNDS: SIADH and Escitalopram ( lexapro)
- CONSULT ROUNDS: Clinical dilemma in Nephrogenic Di...
- CONSULT ROUNDS: Metformin toxicity, Lactic Acidosi...
- CLINICAL CASE 7
- IN THE NEWS- HgA1C for Diabetes Diagnosis. How abo...
- KIDNEY DONORS have Good Long term survival
- TOPIC DISCUSSION: VEGF Nephropathology
- TOPIC DISCUSSION: Post Transplant Collapsing FSGS,...
- Post Transplant Collapsing FSGS: Is it really all ...
- CLINICAL CASE 6
- Topic Discussion: OUCH!! Should Anesthesia Hurt??
- TOPIC DISCUSSION: Alcohol Poisonings, gaps and osm...
- Belatacept approved by FDA
- Protocol Biopsies in Renal Allograft Recipients
- ▼ March (37)