Renal transplant nephrectomy.

There is surprisingly little about the problems of transplant nephrectomy reported in the literature, despite the frequency of the procedure and the recognition that it can be a difficult technical challenge. Of 480 kidneys transplanted during a ten year period, 154 (32 per cent) were later removed. One hundred and eleven (72 per cent) nephrectomies were performed because of uncontrollable acute rejection within three months of transplantation. Thirty-eight (25 per cent) nephrectomies were performed because of graft failure due to chronic rejection and five (3 per cent) were carried out for other reasons. The only significant problem that occurred during graft nephrectomy was difficulty in controlling bleeding which occurred at nine (6 per cent) operations. No patient died during the operation. In the postoperative period, there were two (1 per cent) complications, perforated peptic ulcer and pseudomembranous colitis, which led to death and 22 (14 per cent) which were successfully treated. These consisted of nine infections, five lymph leaks, four hematemeses, three secondary hemorrhages and one urine leak. No significant difference could be shown in morbidity and mortality with respect to the time lapse between transplantation and graft nephrectomy. Transplant nephrectomy need not be as hazardous a procedure as has often been recorded provided it is not performed by an inexperienced surgeon, although the decision as to when to abandon a graft is often a finely balanced one.