Clinicopathological correlation of transplant nephrectomies in elusive graft dysfunction - An observational study

Abstract

Aim: The objective of this study is to review the pathology and outcome of kidney allograft nephrectomies performed in a single renal transplant center in South India. In our regional center, a total of 721 renal transplants were done between January 2001 and March 2020, of which 18 underwent transplant nephrectomy (TN). Materials and Methods: Clinical data concerning patient characteristics, duration of allograft functions, indications, complications, and subsequent follow-up details were assessed. The median age of patients at the time of transplantation who underwent TN was 35 years. Among the 18 allografts, 16 were from live-related donors and a deceased donor after circulatory/brain death in two patients. Associated comorbidities found at the time of transplantation mainly consist of diabetes mellitus, hypertension, and coronary artery disease. A standard triple immunosuppressive regimen along with mTOR inhibitors was followed in all patients. The morphology of the allograft nephrectomy was studied in elusive graft dysfunction. Results: In our study, while the infection was found to be the leading cause of renal allograft failure clinically, on pathological examination of TN specimens, rejection (44.44%) contributed to failure the most. Early graft failure (55.56%) was related to hyperacute rejection or vascular complications. Late graft failure (44.44%) was associated with infection and rejection. No significant mortality was observed in our study. Conclusion: Clinicopathological correlation to arrive at a diagnosis for graft failure contributes to more effective postnephrectomy care of the patient since often the underlying pathology is masked by other incidental occurrences. It also aids in gauging the patient's chances of undergoing further transplant and graft survival.