Keywords
kidney transplant
graft intolerance syndrome
graft loss
nephrectomy
How to Cite
Abstract
Background: The renal graft intolerance syndrome is an inflammatory process that occurs in one third of the kidney transplant patients with graft loss. If medical treatment for intolerance graft syndrome is not effective, there is an indication of graft nephrectomy. However, graft nephrectomy has higher morbidity and mortality compared to non-invasive techniques. Due to a high fragility in kidney transplant patients, the renal arterial embolization has become a useful minimally invasive therapeutic option for intolerance graft syndrome.
Objective: We aim to describe the use of renal arterial embolization for renal graft intolerance syndrome.
Case presentation: We report three clinical cases who were admitted to the emergency department for a history of twenty days of graft pain and swelling. These patients had fever, hyporexia, weight loss and macroscopic hematuria. None of the cases had clinical improvement with immunosuppression adjustment and a diagnosis of renal graft intolerance syndrome was made dismissing infection. Patients were treated with renal arterial embolization and its procedure success were determined as the symptom’s resolution.
Discussion and conclusion: After 24- and 48-hours post-embolization, patients were successfully recovered and discharged in the hospital. Renal graft arterial embolization is a safe and non-invasive alternative to graft nephrectomy to treat renal intolerance syndrome.
References
Akoh JA. Transplant nephrectomy. World J Transplant. 2011;1(1):4–12.
Chowaniec Y, Luyckx F, Karam G, Glemain P, Dantal J, Rigaud J, et al. Transplant nephrectomy after graft failure: is it so risky? Impact on morbidity, mortality and alloimmunization. Int Urol Nephrol. 2018;50(10):1787–93.
López-Gómez JM, Pérez-Flores I, Jofré R, Carretero D, Rodríguez-Benitez P, Villaverde M, et al. Presence of a failed kidney transplant in patients who are on hemodialysis is associated with chronic inflammatory state and erythropoietin resistance. J Am Soc Nephrol. 2004;15(9):2494–501.
Kaplan B, Meier-Kriesche HU. Death after graft loss: An important late study endpoint in kidney transplantation. Am J Transplant. 2002;2(10):970–4.
Bunthof KLW, Verhoeks CM, van den Brand JAJG, Hilbrands LB. Graft intolerance syndrome requiring graft nephrectomy after late kidney graft failure: can it be predicted? A retrospective cohort study. Transpl Int. 2018;31(2):220–9.
Bonani M, Achermann R, Seeger H, Scharfe M, Müller T, Schaub S, et al. Dialysis after graft loss: a Swiss experience. Nephrol Dial Transplant. 2020;35(12):2182–90.
Ryu H, Kim YC, Moon JJ, Song EY, Min S il, Ha J, et al. Weaning Immunosuppressant in Patients with Failing Kidney Grafts and The Outcomes: A Single-Center Retrospective Cohort Study. Vol. 10, Scientific Reports. 2020.
Fantoni M, Marcato C, Ciuni A, Pellegrino C, Russo U, Zannoni R, et al. Renal artery embolization of non-functioning graft: an effective treatment for graft intolerance syndrome. Radiol Medica. 2020;(0123456789):1–4.
Garcia-Padilla PK, Afanador D, Gonzalez CG, Yucuma D, Uribe J, Romero A. Renal Graft Embolization as a Treatment for Graft Intolerance Syndrome. Transplant Proc. 2020;52(4):1187–91.
Muller A, Rouvière O. Renal artery embolization-indications, technical approaches and outcomes. Nat Rev Nephrol. 2015;11(5):288–301.
Pérez-Flores I, Sánchez-Fructuoso A, Marcén R, Fernández A, Lucas MF, Teruel JL. Manejo del injerto renal fallido. Nefrectomía versus embolización. Nefrologia. 2009;29(SUPP.1):55–61.
Andrews PA. Summary of the british transplantation society guidelines for management of the failing kidney transplant. Transplantation. 2014;98(11):1130–3.
Pham PT, Pham PC. Immunosuppressive Management of Dialysis Patients with Recently Failed Transplants. Semin Dial. 2011;24(3):307–13.
Delgado P, Diaz F, Gonzalez A, Sanchez E, Gutierrez P, Hernandez D, et al. Intolerance syndrome in failed renal allografts: Incidence and efficacy of percutaneous embolization. Am J Kidney Dis. 2005;46(2):339–44.
Krause I, Cleper R, Belenky A, Atar E, Bar-Nathan N, Davidovits M. Graft intolerance syndrome in children with failed kidney allografts - Clinical presentation, treatment options and outcome. Nephrol Dial Transplant. 2008;23(12):4036–40.
Ghyselen L, Naesens M. Indications, risks and impact of failed allograft nephrectomy. Transplant Rev. 2019;33(1):48–54.
Transplantation B, Guidelines S. Management of the failing kidney transplant. Br Transplant Soc. 2014;
Al Badaai G, Pernin V, Garrigue V, Monnin V, Murez T, Fadli SED, et al. Renal graft intolerance syndrome in late graft failure patients: efficacy and safety of embolization as first-line treatment compared to surgical removal. Transpl Int. 2017;30(5):484–93.
Takase HM, Contti MM, Nga HS, Bravin AM, Valiatti MF, El-Dib RP, et al. Nephrectomy versus embolization of non-functioning renal graft: A systematic review with a proportional meta-analysis. Ann Transplant. 2018;23:207–17.
Satué CG. Utilidad de la embolización percutánea del injerto renal no funcionante como alternativa a la transplantectomía quirúrgica?: su influencia en la sensibilización del paciente. Universidad Autonoma de Barcelona; 2007.
Pérez Martínez J, Gallego E, Juliá E, Llamas F, López A, Palao F, et al. Embolización del injerto renal no funcionante: Eficacia y control del estado inflamatorio crónico. Nefrologia. 2005;25(4):422–7.
Johnston O, Rose C, Landsberg D, Gourlay WA, Gill JS. Nephrectomy after transplant failure: Current practice and outcomes. Am J Transplant. 2007;7(8):1961–7.
Morales A, Gavela E, Kanter J, Beltrán S, Sancho A, Escudero V, et al. Treatment of Renal Transplant Failure. Transplant Proc. 2008;40(9):2909–11.
Secin FP, Rovegno AR, Brunet MDR, Marrugat REJ, Michel MD, Fernández H. Cumulative incidence, indications, morbidity and mortality of transplant nephrectomy and the most appropriate time for graft removal: Only nonfunctioning transplants that cause intractable complications should be excised. J Urol. 2003;169(4):1242–6.
Marcén R, Teruel JL. Patient outcomes after kidney allograft loss. Transplant Rev. 2008;22(1):62–72.
Lorenzo V, Díaz F, Perez L, Domínguez ML, Machado M, Rodríguez A, et al. Ablation of Irreversibly Rejected Renal Allograft by Embolization With Absolute Ethanol: A New Clinical Application. Am J Kidney Dis. 1993;22(4):592–5.
Cofán F, Vilardell J, Gutierrez R, Real M, Montanya X, Oppenheimer F, et al. Efficacy of renal vascular embolization versus surgical nephrectomy in the treatment of nonfunctioning renal allografts. Transplant Proc. 1999;31(6):2244–5.
Langone AJ, Chuang P. The management of the failed renal allograft: An enigma with potential consequences. Semin Dial. 2005;18(3):185–7.
Antón-Pérez G, Gallego-Samper R, Marrero-Robayna S, Henríquez-Palop F, Rodríguez-Pérez JC. Trasplantectomía tras fallo del injerto renal. Nefrologia. 2012;32(5):573–8.
Atar E, Belenky A, Neuman-Levin M, Yussim A, Bar-Nathan N, Bachar GN. Nonfunctioning renal allograft embolization as an alternative to graft nephrectomy: Report on seven years’ experience. Cardiovasc Intervent Radiol. 2003;26(1):37–9.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.