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Henrique Mochida Takase, Mariana Moraes Contti, Hong Si Nga, Ariane Moyses Bravin, Mariana Farina Valiatti, Regina Paolucci El-Dib, Luis Gustavo Modelli de Andrade
(Department of Internal Medicine, University of Estadual Paulista, São Paulo, SP, Brazil)
Ann Transplant 2018; 23:207-217
There is no standardization on the timing of the best approach to treat a non-functioning renal graft.
We reviewed the literature and performed a proportional meta-analysis of case series of transplantectomy and embolization for a non-functioning renal graft. The groups were compared for mortality and morbidity outcomes.
A total of 2421 patients were included in this review. Of these, 2232 patients underwent transplantectomy and 189 underwent percutaneous embolization. The mortality rate in the nephrectomy group was 4% [95% confidence interval [CI], 2–7%; I²=87%] as compared with 0.1% [95% CI, 0.1–0.5%; I²=0%] in the embolization group. The rates of common morbidities were 18% [95% CI, 13–26%, I²=79.7%] for nephrectomy compared with 1.2% [95% CI, 0.7–2.1%, I²=26.4%] for embolization. The incidence of post-embolization syndrome was 68%, and 20% of patients needed post-embolization nephrectomy.
Percutaneous embolization was associated with lower mortality and morbidity rates but also with a high rate of post-embolization syndrome. However, in most cases this complication had easily manageable symptoms. Embolization is a new and attractive technique that can be considered in treating non-functioning renal grafts.