The advisability of routine allograft
nephrectomy following rejection has not been clearly resolved. Rejected transplants may be a source of
sepsis, local inflammatory symptoms, and continued antigenic stimulation. Transplant
nephrectomy is, however, attended by a surprisingly high incidence of septic complications and death. In an attempt to analyze the occurrence of these, and identify effective prophylactic maneuvers, the authors retrospectively studied 99 consecutive allograft
nephrectomies in 252 consecutive renal transplants. Mortality following allograft
nephrectomy was 10 per cent, and usually attributable to
sepsis.
Wound infections occurred in 24 per cent of these patients and were significantly associated with a preoperative site of
infection in the
wound, urinary tract, or blood (P less than 0.01). Preoperative
antibiotics,
wound irrigation, drains, and delay in performing allograft
nephrectomy were all found to be insignificant variables. Interestingly, total
steroid dose was less in patients who developed
wound infections than in those who did not (P less than 0.01). A
postoperative wound infection approximately doubled the mean number of hospital days. These data suggest that a significant reduction in morbidity and possibly mortality could be accomplished by complete eradication of
infection prior to allograft
nephrectomy. Consequent delay in removal of the graft is not associated with increased morbidity, and other maneuvers seem to have little beneficial effect.