Transvascular ethanol embolization: first option for the management of symptomatic nonfunctioning renal allografts left in situ

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 inmmunosuppresion. 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 prophylatic 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.