Nefrectomia versus embolização após a perda do enxerto renal: uma revisão sistemática com metanálise proporcional de estudos de séries de casos

• Autor(a) principal: Takase, Henrique Mochida [UNESP]
• Data de Publicação: 2017
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNESP
• Texto Completo: http://hdl.handle.net/11449/149836
• topic: Transplante renal; Nefrectomia; Embolização

Introduction: There are two thecniques to the treatment of disfunctional renal graft: nephrectomy and percutanic embolization. Until this moment, there are no controled randomized trial comparing efectiviness of each thecnique. Objective: To determine which one is the best thecnique to the disfunctional renal graft: nephrectomy or percutaneous embolization. Methods: Literature review and proportional meta-analysis off all available case series about nephrectomy/embolization in renal transplantation after loss of graft function. The nephrectomy and embolization groups were compared on mobidity and mortality for any cause. Morbidities were separeted in two categories: comuns morbidities for nephrectomy and embolization, bleeding, wound infections, septicemia, lung infection, abscesses and/or collections and aneurysm and specific embolization morbidities, post embolization syndrome and need for nephrectomy after the procedure. Results: A total of 2,421 patients were included in this revision, Of these, a total of 2,232 patients underwent nephrectomy, amd the remaining 189 underwent percutaneous embolization. The mortality rate in the nephrectomy group was 4% [IC 95% 2-8%; I2 = 87%] compared to 0,1% [IC 95% 0,1 - 0,5%; I2= 0%] in the embolization group. There was significant difference between the two groups, with no ovrlap of confidence intervals. The morbidity datas for nephrectomy show an incidence of 19% [IC 95% 15-25%, I2 = 79,7%] comparing to a 1,1% [lC 95% 0,6 - 2,2%, I2 = 26,4%] in the embolization group. There are no overlap of confidence intervals, showing a difference in the morbidities between the two studieds groups. Post-embolization syndrome had an incidence of 68% in patients submitted to embolization embolização [IC 95% 57 - 82%, I2 = 62,5%]. While the need for post-embolization nephrectomy ocurred in 20% of the cases [IC 95% 11 - 38%, I2 = 67,7%]. Discussion: To date, not exist a technique for removal of the dysfunctional graft after renal transplantation. Removal of the graft occurs in cases of intolerance syndrome or persistence of the chronic inflammatory state. Comparing the two techniques, percutaneous embolization appears as a technique with lower rates of mortality and morbidity. However, with a high rate of post-embolization syndrome, which is a specific complication of this therapy, but in most cases, it presents symptoms of easy handling. The need for nephrectomy after embolization occurs due to failure in therapy and may be tolerable. Conclusion: Percutaneous embolization has lower rates of mortality and morbidity, common to less invasive procedures. Embolization may be a new and attractive technique despite the high rate of post-embolization syndrome.