Introduction: Morbidity associated with allograft nephrectomy (AN) for treatment of failed or diseased kidney transplants is well documented. Pre-operative angiographic kidney embolization (PAKE), which induces allograft infarction prior to planned nephrectomy, has been proposed as an intervention that may decrease complications associated with AN. The study purpose was to compare our experience with AN with and without PAKE. Methods: Single center retrospective review of all adult patients (pts) undergoing AN. Two study groups were identified: PAKE prior to AN and traditional AN without PAKE. Angiography was performed by subspecialty trained interventional radiologists within 24 hours of planned AN. A subcapsular technique for AN was performed unless treating allograft malignancy, in which case an extracapsular approach was attempted. Results: From 2002-2017, 85 pts underwent AN. 10 pts that underwent AN within 1 week of transplant, most commonly secondary to vascular thrombosis, were excluded given the pre-dissected surgical field. Of the 75 pts included in the analysis, 47 underwent PAKE prior to AN and 28 underwent AN without PAKE. Mean timing of AN post kidney transplant was 43±56 months. Most common reasons for AN included allograft intolerance syndrome (n=40), chronic graft infection (n=10), vascular event (n=9), primary non-function (n=7), malignancy (n=6), and other (n=3). Mean age between groups was similar (50±16 PAKE AN vs 52±13 yrs AN; NS). Pre-operative hemoglobin did not differ significantly between groups (mean 10.3±1.2 PAKE AN vs 10.6±1.5 mg/dL AN; NS), however PAKE AN was associated with reduced blood loss (mean 236±227 PAKE AN vs 389±412 cc AN; p=0.03) and reduced intra-operative blood transfusions (mean 0.3±0.8 PAKE AN vs 1.5±2.0 units pRBC AN; p=0.002). Mean operative time (139±40 PAKE AN vs 199±109 min AN; p=0.001) and mean length of stay (3.8±1.25 PAKE AN vs 9.1±9.7 days AN; p=0.0005) all favored PAKE prior to AN. Conclusion: PAKE may result in less blood loss, fewer transfusions, reduced operating time and shorter length of stay, which may translate into reductions in cost and morbidity.

CITATION INFORMATION: Harriman D., Mujumdar V., Farney A., Rogers J., Orlando G., Reeves-Daniel A., Stratta R. Does Pre-Operative Angiographic Kidney Embolization Decrease Complications in Allograft Nephrectomy? Am J Transplant. 2017;17 (suppl 3).

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