ROENTGENOENDOVASCULAR EMBOLIZATION OF NEPHROTRANSPLANT ARTERIES AS A STAGE OF TRANSPLANTECTOMY

Aim. To improve the results of surgical treatment of patients with chronic transplant nephropathy (CTN) in nephrotransplantectomy (NTE) using preventive endovascular transplant arteries embolization (ETAE). Materials and methods. The results of clinical examination and surgical treatment of 30 patients with chronic transplant nephropathy in the period from 2004 to 2012 were assessed. Patients were divided into two groups: group 1, in which NTE was performed after ETAE and group 2 – NTE without ETAE. Both groups were compared by the hemorrhage volume, surgical complications, medical measures. Results. Intraoperative hemorrhage in group 1 was from 20 to 50 ml, on the average 40±10,5 ml. In group 2 – from 100 to 600 ml, on the average 295±50,4 ml ( p =0,04). No surgical complications, such as vascular damage when performing NTE in group 1 were noted. In group 2 there was registered vascular damage in 15% of cases ( n =3).No intra-and postoperative hemotransfusions connected with hemorrhage were detected in group 1. In group 2 erythrocytic mass infusion was administered in 75% of cases ( n =15). Conclusion. Preventive ETAE permits to significantly reduce the hemorrhage degree (from 295±50,4 ml to 40±10,5 ml) during NTE that is very important for patients with nephrogenic anemia against the background of tCPN transplant. ETAE allows to completely abolish immunosuppression in the early period after this manipulation, to carry out nephrectomy in the delayed terms and to grade the risk of immunological conflict with subsequent allotransplantations to these recipients.

Kidney allotransplantation, chronic transplant nephropathy, nephrotransplantectomy, transplant arteries embolization, hemorrhage