Extracapsular versus intracapsular allograft nephrectomy: impact on allosensitization and surgical outcomes

Authors

  • Naji J. Touma Division of Urology, University of Western Ontario, London, ON
  • Alp Sener Division of Urology and Multiorgan Transplant Program, University of Western Ontario, London, ON
  • Yves Caumartin Division of Urology and Multiorgan Transplant Program, University of Western Ontario, London, ON
  • Jeff Warren Division of Urology and Multiorgan Transplant Program, University of Western Ontario, London, ON
  • Christopher Y. Nguan Division of Urology and Multiorgan Transplant Program, University of Western Ontario, London, ON
  • Patrick P.W. Luke Division of Urology and Multiorgan Transplant Program, University of Western Ontario, London, ON

DOI:

https://doi.org/10.5489/cuaj.561

Abstract

Introduction: Our objective was to compare the impact of extracapsular
(ECAN) versus intracapsular allograft nephrectomy (ICAN)
on allosensitization and surgical outcomes.

Methods: Between 1990 and 2004, 96 allograft nephrectomies
were performed at our institution. Of these, 29 procedures were
performed within 1 month of the transplant and were therefore
omitted from analysis. Overall, the results of 44 ECAN and 23
ICAN were reviewed.

Results: The mean operative times were 110.9 versus 130.4 min
for ICAN versus ECAN (p = 0.02) and the estimated blood loss
was 226 mL for ICAN versus 483 mL for ECAN (p = 0.004).
Intraoperative and postoperative complications were low using
either technique and differences were not statistically significant.
Overall, the preoperative to postoperative change in the percentage
of panel reactive antibody was +2.1% for ICAN versus +1.2% for
ECAN (NS) at 3 to 12 months postoperatively, respectively (NS).
The percentage of patients relisted was 33.3% versus 54.3% (NS),
and the percentage of patients re-transplanted once relisted was
also very similar: 63.2% for ECAN versus 66.7% for ICAN (NS),
after a mean follow-up of 4.5 and 8.4 years, respectively.

Conclusions: ICAN can be performed with shorter operative times
and less blood loss versus the extracapsular approach. As well, this
operative approach does not appear to affect allosensitization and
the ability to re-transplant patients.

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Author Biographies

Naji J. Touma, Division of Urology, University of Western Ontario, London, ON

Alp Sener, Division of Urology and Multiorgan Transplant Program, University of Western Ontario, London, ON

Yves Caumartin, Division of Urology and Multiorgan Transplant Program, University of Western Ontario, London, ON

Jeff Warren, Division of Urology and Multiorgan Transplant Program, University of Western Ontario, London, ON

Christopher Y. Nguan, Division of Urology and Multiorgan Transplant Program, University of Western Ontario, London, ON

Patrick P.W. Luke, Division of Urology and Multiorgan Transplant Program, University of Western Ontario, London, ON

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How to Cite

Touma, N. J., Sener, A., Caumartin, Y., Warren, J., Nguan, C. Y., & Luke, P. P. (2013). Extracapsular versus intracapsular allograft nephrectomy: impact on allosensitization and surgical outcomes. Canadian Urological Association Journal, 5(1), 49–52. https://doi.org/10.5489/cuaj.561

Issue

Vol. 5 No. 1 (2011): February

Section

Original Research

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