Mazzucchi Eduardo, Nahas Wiliam C, Antonopoulos Ioannis M, Piovesan Afonso C, Ianhez Luis E, Arap Sami
Renal Transplantation Unit, Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.
J Urol. 2003 Sep;170(3):734-7. doi: 10.1097/01.ju.0000080566.42381.94.
Transplant nephrectomy has been considered a hazardous procedure throughout transplantation history. Better surgical techniques and clinical treatment of patients have improved the results of this surgery in the last decades. We report the surgical complications of nephrectomy of early and late failed kidneys performed at a referral center.
The charts of 70 consecutive patients who underwent graft nephrectomy between May 1994 and April 2002 were reviewed regarding surgical complications. Patients were divided into 2 groups according to the timing of graft removal. Early nephrectomy group 1 included 23 procedures performed in the first 60 days after transplantation and late nephrectomy group 2 included 47 performed after that interval. Groups were compared concerning outcome, blood loss and amount of blood transfused in the perioperative period, and the incidence of surgical complications according to the surgical technique, immunosuppressive regimen and timing of surgery.
Mean blood loss was 434 ml (range 20 to 3,000) in group 1 and 546 (range 60 to 2,200) in group 2 (p = 0.02). Nine group 1 patients (39.1%) and 22 in group 2 (46.8%) received blood transfusion in the perioperative period (p = 0.62). The mean amount of blood transfused was 516.7 ml in group 1 and 436.3 ml in group 2 (p = 0.36). Four and 2 minor surgical complications occurred in groups 1 and 2 (17.4% and 4.3%, respectively, p = 0.09). Seven major complications were noted in group 2 (14.9%), while there were none in group 1 (p = 0.05). Three complications (25%) occurred in patients who received antirejection globulins or methylprednisolone and 1 (9.1%) developed when these agents were not administered (p = 0.33). The incidence of surgical complications after intracapsular and extracapsular nephrectomy was 20% and 17.6%, respectively (p = 0.58). Mean blood loss and the mean amount of blood transfused was 638 and 525 ml for intracapsular nephrectomy and 383 and 350 ml for extracapsular nephrectomy, respectively, respectively. Surgical complications occurred in 3 patients who received mycophenolate mofetil (23.1%) and in 6 (17.6%) who did not received this drug (p = 0.48).
Blood loss and surgical complication rates were higher in late failed graft nephrectomies. Surgical complications in intracapsular vs extracapsular nephrectomies were similar but blood loss and transfusions were higher for intracapsular nephrectomy. Acute rejection treatment, or prophylaxis with methylprednisolone or globulins increased the incidence of surgical complications.
在整个移植史上，移植肾切除术一直被认为是一种危险的手术。在过去几十年中，更好的手术技术和患者的临床治疗改善了该手术的结果。我们报告了在一家转诊中心进行的早期和晚期失功肾肾切除术的手术并发症。
回顾了1994年5月至2002年4月期间连续70例行移植肾切除术患者的病历，以了解手术并发症情况。根据移植肾切除的时间将患者分为两组。早期肾切除术组1包括移植后前60天内进行的23例手术，晚期肾切除术组2包括在此间隔后进行的47例手术。比较两组在围手术期的结局、失血量、输血量，以及根据手术技术、免疫抑制方案和手术时间的手术并发症发生率。
组1的平均失血量为434毫升（范围20至3000毫升），组2为546毫升（范围60至2200毫升）（p = 0.02）。组1中有9例患者（39.1%）和组2中有22例患者（46.8%）在围手术期接受了输血（p = 0.62）。组1的平均输血量为516.7毫升，组2为436.3毫升（p = 0.36）。组1和组2分别发生4例和2例轻微手术并发症（分别为17.4%和4.3%，p = 0.09）。组2中发现7例严重并发症（14.9%），而组1中无严重并发症（p = 0.05）。3例接受抗排斥球蛋白或甲泼尼龙的患者发生并发症（25%），未使用这些药物时1例患者发生并发症（9.1%）（p = 0.33）。囊内肾切除术和囊外肾切除术后的手术并发症发生率分别为20%和17.6%（p = 0.58）。囊内肾切除术的平均失血量和平均输血量分别为638毫升和525毫升，囊外肾切除术分别为383毫升和350毫升。接受霉酚酸酯的3例患者发生手术并发症（23.1%），未接受该药物的6例患者发生手术并发症（17.6%）（p = 0.48）。
晚期失功移植肾肾切除术的失血量和手术并发症发生率较高。囊内肾切除术与囊外肾切除术的手术并发症相似，但囊内肾切除术的失血量和输血量更高。急性排斥反应治疗或用甲泼尼龙或球蛋白进行预防会增加手术并发症的发生率。
