Doctor Siaw Wee, Mary Teo1, Associate Professor David Goodman1, Doctor Sharon Ford1, Professor Frank Ierino1
1St Vincent’s Hospital Melbourne, , Australia
Aim: To review and compare mortality and retransplantation outcomes of patients with transplant failure in our centre who underwent allograft nephrectomy against those who did not. Immunosuppression cessation patterns post graft failure was also examined in detail.
Background: There is a lack of clinical consensus in the management of a failed renal allograft with respect to weaning immunosuppression and decision of nephrectomy, the latter of which is associated with risks of surgery and increased anti-HLA sensitisation. The optimal pathway for failed transplantation requires further study.
Methods: A retrospective analysis was performed on 48 patients who returned to dialysis following kidney transplantation failure in the years 2010 to 2020. Of these, 27 (56.3%) underwent a transplant nephrectomy and 21 (43.8%) weaned immunosuppression without requiring nephrectomy. Patients’ clinical data, transplant characteristics, immunosuppression management, mortality and retransplantation outcomes were collected and compared between the two groups.
Results: The allograft nephrectomy group had a trend toward lower mortality compared to those who did not undergo nephrectomy (11.1% vs 33.3%, RR 0.33, p = 0.060). There was a significant difference in the number of patients relisted or worked up for retransplantation favouring the allograft nephrectomy group (70.4% vs 38.1%, RR 1.85, p=0.025). Of those relisted, a smaller proportion of those in the nephrectomy group proceeded to retransplantation (52.6% vs 62.5%, p=0.64). 85.2% of the nephrectomy group and 71.4% of the non-nephrectomy group ceased immunosuppression within the first year.
Conclusions: Despite concerns regarding the risks of allograft nephrectomy, the nephrectomy group demonstrated a trend towards improved mortality outcomes and no significant difference in rates of retransplantation. This suggests that nephrectomy may be a valuable treatment option for patients with transplant failure.
Biography:
Mary Teo is a General Medical Advanced Trainee at St Vincent’s Hospital, Melbourne with interests in general nephrology, renal transplantation and immunology.