Abstract
Kidney transplantation is recognised as the gold standard treatment of end-stage renal disease in most children, with excellent graft survival rates. When graft failure occurs, renal transplant recipients (RTRs) have the option of removal of the transplant (graft nephrectomy [GN]), or leaving the failed transplant in situ. The aims of this review are to discuss the indications for GN, surgical techniques, outcomes after GN (including risks of allosensitisation and the impact on subsequent transplants), and the possible role of routine GN in the asymptomatic RTR with a failed renal allograft. Literature in both the pediatric and adult renal transplant fields is reviewed. We also discuss how future research in this area could advance our knowledge of which patients to select for GN, and the most appropriate surgical approach.
Highlights
Renal transplantation is widely recognised as the gold standard treatment of end-stage renal disease in children
Relatively little has been written in the pediatric literature on this subject, and to our knowledge, only one national guideline has been published [4]. It is not known whether or not failed renal allografts should be routinely removed, i.e. in asymptomatic renal transplant recipients (RTRs). This is of particular importance in pediatric RTRs because of the need to avoid HLA sensitisation, and optimise the child’s opportunity to receive further renal transplants in the future [5]
This review focuses on the indications for GN, surgical techniques, outcomes after GN, risks of allosensitisation after GN, and the impact on subsequent outcomes after re-transplantation
Summary
Renal transplantation is widely recognised as the gold standard treatment of end-stage renal disease in children. Previous studies have shown that more than half of children with failed renal allografts undergo GN [2, 3], suggesting that GN occurs frequently in the pediatric RTR population. Relatively little has been written in the pediatric literature on this subject, and to our knowledge, only one national guideline has been published [4] It is not known whether or not failed renal allografts should be routinely removed, i.e. in asymptomatic RTRs. In addition, it is not known whether or not failed renal allografts should be routinely removed, i.e. in asymptomatic RTRs This is of particular importance in pediatric RTRs because of the need to avoid HLA sensitisation, and optimise the child’s opportunity to receive further renal transplants in the future [5]. Absolute indications include: 1. Unsalvageable acute venous graft thrombosis: GN should be performed to prevent graft rupture and catastrophic bleeding
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