Higher graft salvage rate in renal allograft rupture associated with acute tubular necrosis
Section snippets
Patients and methods
Between January 1990 and January 2001, 657 renal transplants were performed from 146 non–heart-beating donors and from 506 heart-beating cadaveric donors. Ten patients (1.5%) displayed RAR. Data from the RAR transplants were compared to the 647 renal transplants without RAR. We analyzed donor and recipient variables: age, race, gender, transplant number, highest and current panel reactive antibody (PRA >25% or ≤25%), signs and symptoms, day of rupture and plasma creatinine that day, HLA
Results
Ten cases of RAR were diagnosed after kidney transplant (1.5%), including six organs from non–heart-beating donors (4.1%) and four (0.8%) from heart-beating donors (RR 5.03, 95% CI 1.44 to 17.6, P < .01). The mean time (range) to rupture was 7.5 days (1 to 10) after transplant. The characteristics of the patients are summarized in Table 1. Patients with RAR showed a higher incidence of delayed graft function (P < .001) and peak PRA (P < .05) compared with patients without RAR. Donor and
Discussion
Renal allograft rupture is a complication that tends to occur during the first postoperative weeks secondary to the lack of perirenal fibrosis needed to prevent it; only the renal capsule is available.6 Most of the cases of RAR occured in the first 2 to 3 weeks,1, 3 but cases 3 or 4 months later have also been reported.8
Our report of an incidence of 1.5% is compared with previous series describing an incidence between 0.3% and 9.6%.1, 3, 4, 9 Previous to the use of cyclosporine, the most common
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