RESUMEN
INTRODUCTION: Allograft nephrectomy (AN) is not without morbidity following graft failure (GF) in kidney transplantation (KT). METHODS: Single center retrospective review of all adult patients undergoing AN following KT, including a subset of patients who underwent pre-operative angiographic kidney embolization (PAKE). RESULTS: Over a 104 month period, 853 adult patients underwent deceased donor KT. With a median follow-up of 3.5 years, 174 patients (20.4%) developed GF and 38/174 (21.8%) underwent AN. The rate of AN was higher in patients with delayed graft function [DGF, Odds Ratio (OR) 2.15, p = 0.023] and early GF (OR 1.7, p = 0.064). For patients undergoing PAKE (n = 13, mean timing of AN 27.5 months post-KT), the estimated intra-operative blood loss was reduced from a mean of 375 ± 530 to 100 ± 162 ml (p < 0.10), mean peri-operative transfusion requirements were reduced from 3.36 ± 4.8 to 0.23 ± 0.44 units (p < 0.05), and total mean operating time was reduced from 192 ± 114 to 141 ± 38 min (p = NS) compared to 13 control patients undergoing AN in the absence of vascular thrombosis or PAKE. Mean length of hospital stay was decreased from 8.5 ± 9 to 5.5 ± 3 days (p = NS) in patients with PAKE. Surgical complication and infection rates and hospital charges were comparable. CONCLUSIONS: Delayed graft function and early GF are associated with a higher rate of AN. PAKE may result in less blood loss, fewer transfusions, reduced operating time, and shorter length of stay, which may translate into reductions in morbidity.
Asunto(s)
Funcionamiento Retardado del Injerto/terapia , Embolización Terapéutica , Trasplante de Riñón/efectos adversos , Nefrectomía , Radiografía Intervencional , Adulto , Aloinjertos , Pérdida de Sangre Quirúrgica/prevención & control , Transfusión Sanguínea , Distribución de Chi-Cuadrado , Funcionamiento Retardado del Injerto/diagnóstico por imagen , Funcionamiento Retardado del Injerto/etiología , Embolización Terapéutica/efectos adversos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Nefrectomía/efectos adversos , North Carolina , Oportunidad Relativa , Tempo Operativo , Cuidados Preoperatorios , Radiografía Intervencional/efectos adversos , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Insuficiencia del TratamientoRESUMEN
The understanding of renal cell carcinoma has undergone significant advances in the past several years. These have included advances in imaging procedures and surgical approaches, allowing for more precise staging, and individualized approaches to therapy. Furthermore, there has been an increase in the diagnosis of incidental tumors and currently the majority of RCCs are incidentally diagnosed on routing imaging procedures. In this manuscript, we review the surgical options for renal cell carcinoma with specific emphasis on the algorithm for approaching these tumors, in order to ensure maximal cancer specific survival, without threatening the overall renal function.