When a Kidney Transplant Fails; Transplant nephrectomy improves survival

[okarol]

VIDEO: When a Kidney Fails After Transplantation, Ron Shapiro, MD
http://www.medscape.com/viewarticle/721206?src=rss
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MEDLINE Abstract

Transplant nephrectomy improves survival following a failed renal allograft.
J Am Soc Nephrol.  2010; 21(2):374-80 (ISSN: 1533-3450)

Ayus JC ; Achinger SG ; Lee S ; Sayegh MH ; Go AS
Department of Clinical Research, Renal Consultants of Houston, 2412 Westgate Street, Houston, TX, USA. carlosayus@yahoo.com


There is a growing number of patients returning to dialysis after a failed kidney transplant, and there is increasing evidence of higher mortality among this population. Whether removal of the failed renal allograft affects survival while receiving long-term dialysis is not well understood. We identified all adults who received a kidney transplant and returned to long-term dialysis after renal allograft failure between January 1994 and December 2004 from the US Renal Data System. Among 10,951 transplant recipients who returned to long-term dialysis, 3451 (31.5%) received an allograft nephrectomy during follow-up. Overall, 34.6% of these patients died during follow-up. Receiving an allograft nephrectomy associated with a 32% lower adjusted relative risk for all-cause death (adjusted hazard ratio 0.68; 95% confidence interval 0.63 to 0.74) after adjustment for sociodemographic characteristics, comorbidity burden, donor characteristics, interim clinical conditions associated with receiving allograft nephrectomy, and propensity to receive an allograft nephrectomy. In conclusion, within a large, nationally representative sample of high-risk patients returning to long-term dialysis after failed kidney transplant, receipt of allograft nephrectomy independently associated with improved survival.

PreMedline Identifier:19875809
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
http://www.medscape.com/medline/abstract/19875809

[Lisa]

Dr Shapiro is my transplant surgeon!!!   And I just had an allograft nephectomy last tuesday.

[Treasure]

It was difficult to let go of the kidney my son had donated to me, it seemed that my failing transplant was making me seriously sick, and we had to the nephrectomy. Now it seems that may have saved my life, in the long run.  Thanks for posting this article. I will continue to follow this story.

[Jie]

I am not sure the "adjustments" of factors have taken care of all factors. Those who did not have nephrectomy may not be healthy enough for it.  It will be good to know these higher deaths are caused by the failed transplanted kidneys, or something else.