Debulking transplant nephrectomy leaving an intact ureter and instillation of betadine intracapsular is safe nephrectomy: Fifteen years' experience

Abstract

Background. Transplant nephrectomy has been reported to display a high morbidity (17% to 56%) and considerable mortality (13% to 14%). We used a debulking technique leaving an intact ureter with intracapsular instillation of betadine; it was associated with a low rate of complications. Materials and methods. A total of 25 patients (16 males, 9 females) with failed allografted kidneys underwent transplant nephrectomy between 1991 and 2006 (Group 1). All subjects had failed kidneys for 2 months or more posttransplantation. The surgical approach to allograft nephrectomy was via the same oblique incision in the iliac fossa as the original transplantation. The capsule of the allograft was exposed and incised from pole to pole for the renal parenchyma to be bluntly dissected free with an index finger. The kidney parenchyma was pulled outward, and then the pedicle was ligated with silk, and layer by layer the tissue was removed until reaching the pedicle. Again it was transfixed and carefully ligated. After homeostasis, diluted betadine was instilled into the capsule and a drain inserted. The allograft ureter and capsule were left intact. All cases were followed for at least 1 year. Postnephrectomy, small doses of immunosuppressive drugs were continued for at least 2 months. Results. Intracapsular nephrectomy was not associated with a significant complication. Conclusion. Intracapsular debulking nephrectomy, leaving the ureter and capsule intact and with intracapsular instillation of betadine, was a safe technique to remove a delayed, failed allograft.