Introduction: Graft nephrectomy is universally recommended when graft survival is less than 6 months. In case of later graft failure it is not always necessary to remove the graft. Indications for late graft removal include symptoms of graft intolerance (pain, infection, fever, hematuria), the presence of a tumor, or to create space for retransplantation. We aimed to find predictive factors for graft intolerance, which would allow timely identification of patients that might benefit from elective graft nephrectomy.

Methods: We retrospectively collected data of kidney transplantations performed in our centre between 1980 and 2010 that failed at least 6 months after transplantation. We excluded patients if there was a previous graft in situ, when (planned) graft nephrectomy was performed within 3 months after graft failure, or when follow up was less than 3 months. For every patient undergoing graft nephrectomy, we selected a control with a comparable date of graft failure and duration of follow up who did not require graft nephrectomy. With logistic regression we analyzed which patient and graft characteristics were related to the need for late graft nephrectomy. Markers that were univariately associated with graft nephrectomy were considered for a multivariate prediction rule.

Results: 2643 kidney transplantations were performed, of which 716 have failed. In and -exclusion criteria were met in 289 cases. In 73 cases of graft removal (25%), an appropriate control could be selected. Median interval between graft failure and graft removal was 7.7 months (interquartile range: 4.3-11.9). Factors that were associated with graft nephrectomy in multivariate analysis were acute rejection (OR 4.9, p 0.09) or chronic rejection (OR 5.4, p 0.01) as cause of graft failure, prednisone dose at time of graft failure (OR 2.6, p 0.03) and cardiovascular comorbidity (OR 0.3, p 0.009).

Conclusion: In this retrospective analysis, graft failure caused by rejection (acute or chronic), prednisone dose at time of graft failure, and cardiovascular comorbidity were independent predictive factors for graft nephrectomy after late graft failure.

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