Abstract

In this retrospective study, we evaluated acute and chronic graft failures and graft nephrectomy indications in 274 consecutive kidney transplantations (244 living related and 31 cadaveric donors) that were performed at the Ege University Organ Transplantation and Research Center between September 1988 and June 1996. During this period 41 patients experienced graft failure with no concomitant patient loss.

The etiologic factors of graft failure were acute and chronic rejections respectively in 8 and 29 patients, vascular complications in three patients and post-biopsy renal bleeding in one case. 16 (10 male and 6 female) patients underwent graft nephrecfomy. Of the 11 patients with early graft failure, vascular complications and acute accelerated rejections necessitated nephrectomy in 4 and 1 cases respectively. Among 30 patients with chronic graft failure, 11 nephrectomies were performed because of uncontrollable fever, graft tenderness, hematuria, and trombocytopenia that became evident after withdrawal of immunosuppression. On the contrary, neither graft related symptoms nor serious systemic infections were observed in dialysis dependent patients receiving maintenance prednisolone (5-10 mg/day) for a mean of 6 months following acute or chronic graft failure and none underwent graft nephrectomy. As a result we advocate graft nephrectomy for patients with acute graft failure due to vascular complications and accelerated rejections and suggest low dose maintenance prednisolone therapy for either acute or chronic graft failure for the prevention of graft nephrectomy.