Introduction/Objective: After a failed transplant, management of a non-functional graft with pain or recurrent infections can be challenging. Transplant nephrectomy (TN) can be a very morbid procedure with the potential for significant blood loss. Embolization of the renal artery alone has been proposed as a method of reducing complications from an in vivo failed kidney transplant. While this does yield less morbidity, it does not address an infected graft. We elected to begin preoperative embolization to assess if this would help decrease the blood loss and transfusion rate associated with TN.

Methods: We performed a retrospective analysis of all patients who underwent TN at our institution. Patients who had functioning grafts that later failed were included in analysis. TN was performed for recurrent infections, pain or hematuria. We evaluated for blood loss (EBL) during TN, transfusion rate and length of hospital stay.

Results: A total of 16 patients were identified. 9 had preoperative embolization or no blood flow to the graft prior to TN. The remaining 7 did not have preoperative embolization. The shortest time from transplant to TN was 8 months and the longest 18 years with an average of 6.3 years. Average EBL for the embolized patients (ETN) was 143.9 cc compared to 621.4 cc in the nonembolized (NETN) group (p=0.041). Average number of units of blood transfused was 0.44 in the ETN with only 3/9 patients requiring transfusion. The NETN patients had average of 1.29 units transfused with 5/7 requiring transfusion. The length of stay was longer for the ETN at 5.4 days compared to 3.9 in the NETN. No intraoperative complications were seen in either group and only one patient had a postoperative ileus in the NETN.

Conclusion: Embolization prior to TN does significantly decrease the EBL but does not significantly decrease transfusion rate. However, patients do require a significantly longer hospitalization with embolization. Larger studies are needed to determine if embolization before transplant nephrectomy reduces the transfusion rates and overall complications.

CITATION INFORMATION: Yeast C, Riley J, Holyoak J, Weinstein S, Ross G, Wakefield M. Use of Preoperative Embolization Prior to Transplant Nephrectomy. Am J Transplant. 2016;16 (suppl 3).

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