Transplant nephrectomy with peritoneal window: Georgetown University experience
Rachel Rubinz1, Oya M. Andaçoğlu2, Erik Anderson1, William Corder1, Evan Michaelson1, Jack Moore2, Matthew Cooper2, Seyed Ghasemian1,2
1Department of Urology, Georgetown University School of Medicine, Washington, USA
2Georgetown University MedStar Transplant Institute, Washington, USA
Objective: Transplant nephrectomy is a technically challenging procedure with high complication rates. Morbidity and mortality are mostly due to hemorrhage or infection and are reported to be 17-60% and 1-39%, respectively. The most common surgical technique for transplant nephrectomy is sub-capsular, extraperitoneal approach which may result in fluid accumulation and subsequent super-infection. We report that intraperitoneal approach, after assuring hemostasis of the transplant pedicle, allows for passive drainage, decreases hematoma formation and minimizes the subsequent infection risk in the nephrectomy bed.
Material and Methods: From July 2009 to July 2014 a total of 38 transplant nephrectomies were performed using the intraperitoneal window technique at Georgetown University MedStar Transplant Institute (MGTI). Data was collected retrospectively.
Results: Average age at the time of transplant nephrectomy was 43.9 ± 14.3, and the majority were male (55.3%). Mean time to nephrectomy was 71.7 ± 67.4 months following transplantation. Indications for nephrectomy included pain, hematuria, fever, and recalcitrant rejection. Average operative time was 97.1 ± 28.9 minutes, average blood loss was 172.5 ± 213.6 mL. A total of 9 (24%) complications occurred. Postoperative blood transfusion was the most common complication (15.7%) followed by 2 (5.3%) re-interventions; one take back for hematoma and one percutaneous drain placement for symptomatic fluid collection. We had no infection, postoperative sepsis, ICU admissions, or mortality.
Conclusion: Transplant nephrectomy with peritoneal window is a technique with better results compared to the literature. An opening between the transplant cavity and the peritoneum allows for passive drainage of fluid and minimizes the risk of hematoma and abscess formation. This approach does not add significant time to the operation, furthermore it may decrease morbidity and mortality by reducing overall complications, namely hematoma formation and infection, which overall decreases rates of re-interventions and length of hospital stay.
Keywords: Nephrectomy, transplant, transperitoneal
Cite this article as: Rubinz R, Andaçoğlu OM, Anderson E, Corder W, Michaelson E, Moore J, Cooper M, Ghasemian S. Transplant nephrectomy with peritoneal window: Georgetown University institution experience. Turk J Surg 2019; 35 (3): 191-195.
Institutional Review Board (IRB) approval was obtained.
Due to the retrospective design of the study, the informed consent was not obtained.
Consept - M.C., S.G.; Design - M.C., S.G., O.M.A.; Supervision - M.C., S.G.; Resource - R.R., E.A., W.C., E.M., J.M.; Materials - R.R., E.A., W.C., E.M., J.M.; Data Collection and/or Processing - R.R., O.M.A., E.A., W.C., E.M., J.M.; Analysis and Interpretation - O.M.A., S.G., M.C.; Literature Search - R.R., E.A., W.C., E.M.; Writing Manuscript - R.R., O.M.A., S.G.; Critical Reviews - M.C., S.G., O.M.A.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.