Allograft Nephrectomy: What Is the Best Surgical Technique?

Abstract Background The objective of this study was to evaluate differences in outcomes of allograft nephrectomies performed by extracapsular versus intracapsular techniques. Methods From 1993 to 2010, we performed 89 allograft nephrectomies, including 57 by extracapsular techniques and 32 by intrac...

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Bibliographic Details
Published in:Transplantation proceedings 2012-09, Vol.44 (7), p.1922-1925
Main Authors: Vavallo, A, Lucarelli, G, Bettocchi, C, Tedeschi, M, Palazzo, S, Losappio, V, Gesualdo, L, Grandaliano, G, Selvaggi, F.P, Battaglia, M, Ditonno, P
Format: Article
Language:English
Subjects:
Biological and medical sciences
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Graft Survival
Humans
Kidney Transplantation
Medical sciences
Nephrectomy
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Surgical Procedures, Operative - methods
Tissue, organ and graft immunology
Transplantation, Homologous
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Summary:Abstract Background The objective of this study was to evaluate differences in outcomes of allograft nephrectomies performed by extracapsular versus intracapsular techniques. Methods From 1993 to 2010, we performed 89 allograft nephrectomies, including 57 by extracapsular techniques and 32 by intracapsular, chosen according to feasibility at the beginning of the surgery. Fisher exact test and logistic regression were used for statistical analysis. Survival estimates after allograft nephrectomy were calculated according to the Kaplan-Meier method. Results After a mean graft survival of 49.7 months, the indications for transplant nephrectomy were chronic rejection (39.3%), acute rejection (22.5%), infection/sepsis (19.1%), gross hematuria (6.7%), renal vein thrombosis (6.7%), renal artery thrombosis (3.4%), and graft rupture (2.3%). Mean operative time, blood loss, transfusions, and complications were similar between the extracapsular and intracapsular groups. The only difference in surgical aspects between the 2 groups was the mean hospital stay, which was longer for the extracapsular group (13.8 vs 7.6 days; P = .01), a result that was confirmed by multivariate analysis (odds ratio, 1.05; 95% confidence interval, 1.0–1.1; P = .03). Conclusions Our experience showed no significant advantages in favor of the intracapsular technique except for a shorter length of hospital stay than after the extracapsular procedure.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2012.06.011