Böbrek nakli sonrası greft nefrektomi olgularının klinik ve patolojik analizi

Abstract

Amaç: Böbrek transplantasyonunun en sık komplikasyonu olan greft yetmezliği vakalarının sayısı, artan böbrek nakli ameliyatları nedeniyle artmaktadır. Greft nefrektomi, içerdiği yüksek komplikasyon riski nedeniyle greft yetmezliği olan renal transplant alıcılarında son tedavi seçeneğidir. Bu çalışmanın amacı, greft nefrektomi yapılan hastalarda klinik özellikleri, nefrektomi nedenlerini, eksplante edilen greftin patolojik analizini ve cerrahi komplikasyonları değerlendirmektir.
Gereç ve Yöntemler: Merkezimizde 2010-2020 yılları arasında farklı nedenlerle greft nefrektomi geçiren 38 alıcı, retrospektif olarak incelendi. Alıcılar ameliyat zamanına göre iki gruba ayrıldı; klinik ve patolojik özellikleri retrospektif olarak incelendi. Erken greft nefrektomi grubunu, nakil ameliyatından sonraki ilk 6 ayda greft nefrektomi geçiren hastalar, geç greft nefrektomi grubunu ise, ameliyattan 6 ay sonra greft nefrektomi geçiren hastalar oluşturmaktaydı.
Bulgular: Erken greft nefrektomi endikasyonları çoğunlukla vasküler, cerrahi problemler ve enfeksiyon iken, geç greft nefrektomi endikasyonları rejeksiyon ve enfeksiyondu. Rejeksiyon açısından iki grup arasında istatistiksel olarak anlamlı bir fark vardı. Greft sağkalımı, postoperatif vasküler ve cerrahi komplikasyon oranları erken grupta daha yüksekti (sırasıyla p = 0,011 ve p = 0,005). Panel Reaktif Antikor (PRA) pozitifliği değerlendirildi ve iki grup arasında immünolojik risk açısından fark gözlenmedi.
Sonuç: Greft nefrektomi yüksek morbidite ve mortalite oranlarına sahip olduğundan, potansiyel ciddi komplikasyonları önlemek için sadece seçilmiş vakalarda, gerektiğinde uygulanmalıdır.

Keywords

• greft
• nefrektomi
• böbrek
• renal
• transplantasyon
• komplikasyonlar

Clinical and pathological analysis of cases with graft nephrectomy after renal transplantation

Abstract

Objective: The number of cases with graft failure, which is the most frequent complication of renal transplantation, is increasing due to the increasing number of kidney transplant surgeries. Graft nephrectomy is the last treatment option in renal transplant recipients with graft failure due to the high complication risk it entails. The aim of the present study is to evaluate the clinical characteristics, etiologies for nephrectomy, pathological analysis of explanted graft, and surgical complications in recipients with graft nephrectomy.
Material and Methods: We retrospectively analyzed 38 recipients who had undergone graft nephrectomy for different reasons in the center since 2010. The recipients were divided into two groups, according to the time of surgery, with characteristics analyzed retrospectively. The early graft nephrectomy group consisted of patients who had undergone graft nephrectomy in the first 6 months after transplant surgery; the late graft nephrectomy group consisted of patients who had undergone graft nephrectomy more than 6 months after surgery.
Results: Indications for early graft nephrectomy were mostly vascular, surgical problems, and infection, whereas indications for late graft nephrectomy were rejection and infection. There was a statistically significant difference between the two groups with respect to rejection. The rate of graft survival, post-operative vascular and surgical complications were higher in the early group (p=0.011, and p=0.005, respectively). Panel Reactive Antibody (PRA) positivity was evaluated, and no difference was observed between the two groups in terms of immunological risk. 
Conclusions: As graft nephrectomy has high morbidity and mortality rates, it should only be applied in selected cases, where necessary, in order to prevent potentially serious complications.

Keywords

• graft
• nephrectomy
• kidney
• transplantation
• renal
• complications

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