Abstract
Although renal graft percutaneous embolization was introduced to avoid the risk associated with graft nephrectomy, there is no universal consensus about its indications and results. In order to evaluate the efficacy of graft embolization in the treatment of graft intolerance syndrome as well as its safety compared to surgical removal with respect to complications and other morbidity measures, We performed a retrospective observational study comparing two groups of patients treated for graft intolerance syndrome: Group 1: patients who had embolization as first-line treatment and Group 2: patients directly treated by surgical removal. 72 patients were included, (32 in Group 1 and 40 in Group 2); the postintervention follow-up continued for 12 months. Patients in Group 1 are older than those in Group 2. Otherwise, the two groups are similar concerning sex, manifestations of graft intolerance syndrome, diabetes and nutritional and functional status. The overall success rate of embolization in complete resolution of graft intolerance syndrome and ultimately avoidance of surgical removal was 84.37%. The surgical removal group had more serious complications, a longer hospital stay and needed more blood transfusions. We conclude that embolization of symptomatic renal grafts has considerable efficacy with less morbidity, and no serious complications compared to the standard surgical graft removal.
Highlights
Leaving a nonfunctioning renal graft in situ after returning to dialysis and stopping immunosuppressive treatment can become a frustrating problem affecting the quality of life in around 40% of patients, who present the so-called graft intolerance syndrome [1]
In many of these patients, investigations show a chronic inflammation represented by elevated C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR), resulting in resistance of anaemia to erythropoietin-stimulating agents (ESA) [2]
We excluded all patients with a graftrelated condition other than graft intolerance syndrome which might have contributed to the therapeutic decision, like those with a frank acute rejection, renal graft-related cancer, recurrent pyelonephritis or pyonephrosis of the renal graft, or in whom a future renal transplantation was planned after surgical removal of one of the two iliac fossa nonfunctioning renal grafts (Fig. 1)
Summary
Leaving a nonfunctioning renal graft in situ after returning to dialysis and stopping immunosuppressive treatment can become a frustrating problem affecting the quality of life in around 40% of patients, who present the so-called graft intolerance syndrome [1]. Graft intolerance syndrome is clinically manifested by fever, malaise, local pain, gross haematuria, and/or graft tenderness. In many of these patients, investigations show a chronic inflammation represented by elevated C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR), resulting in resistance of anaemia to erythropoietin-stimulating agents (ESA) [2]. Renal graft embolization for late rejection of immunosuppressive therapy in these patients is not advisable due to associated infectious, neoplastic and cardiovascular complications [3,4,5,6]. Medical treatment by nonsteroidal anti-inflammatory drugs and even sometimes the maintenance of low-dose immunosuppressive therapy is of limited long-term efficacy in symptoms resolution and reduction of chronic inflammation [3,7]
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