Renal Allograft Nephrectomy: Comparison Between Clinical and Pathological Diagnosis

BACKGROUND AND AIM: The most common complication of renal transplantation is allograft dysfunction, which in some cases leads to graft loss. The role of graft nephrectomy in the management of transplant failure is controversial. The procedure remains associated with a significant morbidity and also mortality. Our main purpose was the comparison between clinical and pathological diagnosis of graft nephrectomy. PATIENTS AND METHODS: The documents of 88 patients who admitted for graft nephrectomy in Shariaty hospital for the last 25 years were reviewed. Slides of graft pathology were revised by an individual nephropathologist. Data was analyzed by SPSS 18 using ANOVA and Chi-square tests. RESULTS: The percentages of clinical diagnoses for the graft nephrectomy are: chronic rejection (38%), graft infection (26%), gross hematuria (10%), acute rejection (10%), accelerated rejection (8%), hyper-acute rejection (4%) and thrombosis of the renal artery (4). On the other hand, the pathological diagnoses are: necrosis concomitant with thrombosis (35%), only necrosis (26%) and 5 (3) concomitant with 4 (3) in 16% of cases that means severe interstitial atrophy and fibrosis adjacent with acute cellular rejection and intramural vasculitis. CONCLUSIONS: Pathology included necrosis in about half of the graft nephrectomized patients. If the panel reactivity test is negative preoperatively, and there is no absolute indication for the operation, one may abstain from graft nephrectomy to save the patient, the morbidity and even the mortality of the procedure. On the other hand, the advantages of leaving the graft in situ are erythropoietin production, hydroxylation of calcidiol and maintenance of some residual diuresis.