OBJECTIVES: Renal transplantation is currently the treatment of choice for most of the cases with end-stage renal failure. However, approximately 35% present failure of graft function within 5 years post-transplantation. The need for graft removal, which is infrequently discussed in the literature, and the surgical technique employed are discussed. METHODS: From September, 1976 to December, 1994, we have performed 877 renal transplants; of these, 145 (16.5%) required removal. The literature is reviewed, with special reference to the indications for graft removal and the different surgical techniques employed. RESULTS: Our data show that 42% of non-functioning renal transplants required removal at some time. No complications arising from conservative management were observed in the remaining 58%. Graft failure due to acute or early acute rejection invariably necessitated removal; thereafter transplant nephrectomy was uncommon. There were no deaths from failed grafts maintained in situ in this series. CONCLUSIONS: Like other authors, our approach is to leave the graft in situ with or without low doses of corticosteroids. Transplant nephrectomy is reserved for the symptomatic cases. For cases requiring nephrectomy less than three months post-transplantation, we utilize the extracapsular approach; thereafter we utilize the subcapsular technique.
OBJECTIVES: Renal transplantation is currently the treatment of choice for most of the cases with end-stage renal failure. However, approximately 35% present failure of graft function within 5 years post-transplantation. The need for graft removal, which is infrequently discussed in the literature, and the surgical technique employed are discussed. METHODS: From September, 1976 to December, 1994, we have performed 877 renal transplants; of these, 145 (16.5%) required removal. The literature is reviewed, with special reference to the indications for graft removal and the different surgical techniques employed. RESULTS: Our data show that 42% of non-functioning renal transplants required removal at some time. No complications arising from conservative management were observed in the remaining 58%. Graft failure due to acute or early acute rejection invariably necessitated removal; thereafter transplant nephrectomy was uncommon. There were no deaths from failed grafts maintained in situ in this series. CONCLUSIONS: Like other authors, our approach is to leave the graft in situ with or without low doses of corticosteroids. Transplant nephrectomy is reserved for the symptomatic cases. For cases requiring nephrectomy less than three months post-transplantation, we utilize the extracapsular approach; thereafter we utilize the subcapsular technique.