Early graft loss: the Cinderella of transplantation.

Abstract

The loss of a graft in the first few days or weeks of transplantation is a devastating event for the patient and his surgeon. Historically, many early losses were related to hyperacute or aggressive acute rejection, but many centres now find that this is a diminishing cause of graft loss. The role of graft thrombosis has now become a leading cause of such early graft loss. Many centres are now reporting 1-year graft survival rates of the order of 90-95%, and under these conditions are finding that most of the 5-10% lost are thrombosed grafts. The keys to prevention are clearly multifactorial and include careful preparation of the donor, adequate hydration of the recipient, meticulous attention to anatomical and surgical details, the reduction of delayed graft function, and the realization that the non-functioning graft has a high likelihood of being the target of insidious acute allograft rejection. In practical terms, we should ensure that all transplant surgery is done by the most technically capable surgeons, and we should strive to reduce the anastamosis time to below or around 30 min [8]. There is often little justification for anastamosis times in excess of 60 min except for surgical inexperience. Further, there are growing data to suggest that we should no longer be complacent about the apparent length of cold ischaemia that we allow. Perhaps the time has come for renal transplant surgeons to get out of their beds and reduce the maximum cold ischaemia to below 24 h--surely not too onerous a task?(ABSTRACT TRUNCATED AT 250 WORDS)