Clinical Transplantation ProceedingsRenal allograft rupture: a clinicopathologic study of 37 nephrectomy cases in a series of 628 consecutive renal transplants☆
Section snippets
Implantation procedure, immunosuppression
Between October 1, 1979 and December 31, 1998, 628 renal allograft transplantations (cadaveric donors: 623) were performed in the Renal Transplantation Unit, Department of Surgery, Albert Szent-Györgyi Medical University, Szeged. Six hundred twelve recipients were adults and 16 were between the ages of 11 and 16. The donor kidneys were either removed by our team or were received through the National/Eurotransplant program. The majority of the grafts were perfused with Euro-Collins solution. In
Incidence and clinical data
There were 53 cases of RAR (8.4%). The diagnosis of RAR was established by surgical exploration Table 1, Table 2. RAR required graftectomy on 37 occasions (5.9%). The median period between implantation and graftectomy was 9 days (in acute rejection without RAR: 30 days). When three groups were formed on the basis of the introduction of antilymphocyte drugs into the treatment of acute rejection or on the basis of immunosuppression, there was a marked drop in the frequency of RAR. The
Discussion
The material analyzed here is the largest in the literature. Our findings and previous reports suggest that the key event in the pathogenesis of RAR is the imbalance between the extent of renal edema and the current capacity of the efferent renal lymphatics.5, 19, 20, 21 The sonographic data revealed a steady increase in the mean parenchymal width and a significant enhancement (43%) of the graft volume. A previous ultrasound study on RAR demonstrated that a 42% increase in the volume of the
Acknowledgements
We are grateful to Dr Steen Olsen, Copenhagen, Denmark, for critical comments.
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B. Iványi was supported by grants ETT-588/1996-06, OTKA T-016525, and T-025590, Budapest, Hungary.