*Purpose: To determine if morbidity associated with allograft nephrectomy (AN) of a failed or diseased kidney transplant (KT) is improved by pre-operative angiographic kidney embolization (PAKE).

*Methods: We retrospectively reviewed adult KT recipients who underwent AN at our center from 2002-2020. Three patients whose grafts had auto-thrombosed at time of angiography were included in the PAKE group according to intention to treat. Ten patients, who underwent AN within 7 days of KT, and 2 patients, who underwent AN during repeat KT, were excluded.

*Results: A total of 80 remaining patients underwent AN, including 54 (67.5%) who underwent PAKE prior to AN and 26 (32.5%) who underwent AN alone. Time interval between KT and AN was higher in PAKE patients (PAKE: 57±64 months vs AN alone: 24±44 months, p=0.02). Indications for AN included allograft intolerance (n=42), chronic graft infection (n=12), primary nonfunction (n=8), malignancy (n=8), late vascular events (n=7), and other (n=3). There was a trend toward more females in the PAKE group (PAKE: 58.5% female vs AN alone: 38.5%, p=0.1), but no other demographic differences were noted. PAKE was associated with significantly reduced blood loss (PAKE: mean 266±292 ml vs AN alone: 495±689 ml; p=0.04) and reduced transfusion requirements (PAKE: mean 0.5±0.8 packed red blood cell units vs AN alone: 1.6±2.6 units; p=0.004) despite comparable pre-operative hemoglobin levels. Mean operating time (PAKE: 141±43 minutes vs AN alone: 202±111 minutes; p=0.001) and mean length of initial hospital stay (PAKE: 4.3±1.9 days vs AN alone: 9.3±9.4 days; p<0.001) both favored PAKE. PAKE was associated with a lower complication rate [11% (6/54); including vascular injury (2), re-exploration (1), small bowel obstruction (1), incisional hernia (1), and perioperative death (1)], compared to AN alone [38.5% (10/26, p=0.007); including vascular injury (2), wound complication (5), and re-exploration (3)].

*Conclusions: PAKE was associated with less intra-operative blood loss, fewer transfusions, reduced operating time, shorter length of stay, and fewer complications compared to AN alone. More widespread use of PAKE should be considered to potentially reduce morbidity associated with AN. Further study is required to determine if allograft embolization alone as definitive therapy can prevent the need for AN in patients with complications of graft failure.

« Back to 2021 American Transplant Congress