Kidney transplantation after pelvic radiotherapy: Increased morbidity?

Autor:	Françot M; Department of Urology, Nantes University Hospital, Nantes, France. Electronic address: marc_francot@hotmail.fr., Mesnard B; Department of Urology, Nantes University Hospital, Nantes, France., Kerleau C; Center for Research in Transplantation and Translational Immunology, Nantes University Hospital, Nantes, France., Chelghaf I; Department of Urology, Nantes University Hospital, Nantes, France., de Vergie S; Department of Urology, Nantes University Hospital, Nantes, France., Perrouin Verbe MA; Department of Urology, Nantes University Hospital, Nantes, France., Rigaud J; Department of Urology, Nantes University Hospital, Nantes, France., Karam G; Department of Urology, Nantes University Hospital, Nantes, France., Supiot S; Department of Radiotherapy, West Cancer Institute, Nantes University Hospital, Saint-Herblain, France., Rio E; Department of Radiotherapy, West Cancer Institute, Nantes University Hospital, Saint-Herblain, France., Blancho G; Department of Nephrology and Immunology, Nantes University Hospital, Nantes, France., Giral M; Department of Nephrology and Immunology, Nantes University Hospital, Nantes, France., Branchereau J; Department of Urology, Nantes University Hospital, Nantes, France. Electronic address: julien.branchereau@chu-nantes.fr.
Jazyk:	angličtina
Zdroj:	The French journal of urology [Fr J Urol] 2024 Sep; Vol. 34 (9), pp. 102667. Date of Electronic Publication: 2024 Jun 05.
DOI:	10.1016/j.fjurol.2024.102667
Abstrakt:	Introduction: The impact of pelvic irradiation on kidney transplant surgery is still unclear. The main objective of our study is to evaluate the feasibility and the safety of renal transplantation following pelvic radiotherapy. Methods: We collected characteristics and kidney transplant data from patients with a history of pelvic cancer treated with pelvic irradiation between 2005 and 2021. These data were collected via the prospective information system "Computerized Data Validated in Transplantation" (DIVAT) and medical records. We carried out a comparative study with a non-irradiated matched control group to compare the data of intraoperative surgeries, complications reported postoperatively as well as survival of the graft and the patient. Patients were matched on age, sex, side of graft implantation, and graft rank. Results: Twenty-four patients were collected with an average age of 65, 18 patients were treated for prostatic adenocarcinoma, 4 for gynecological cancer and 2 testicular cancers. Twenty-one patients were treated by radiotherapy, 3 by brachytherapy. Eight patients had a target dose on the iliac lymph nodes. The comparative study showed a significant difference in operative difficulty (n=15 versus n=1, P<0.01), operative duration (190min versus 149min, P=0.005), occurrence of lymphocele (P=0.041). Urinary anastomosis surgical techniques were different, 83.3% of control patients had an uretero-vesical anastomosis against 58.3% of patients with a history of irradiation (P=0.057) and about 29% of irradiated patients had an uretero-ureteral anastomosis. There was no other significant difference in per and postoperative criteria or survival. Discussion: A history of pelvic irradiation significantly increases the technical complexity of kidney transplantation without impacting safety and kidney graft survival. A history of pelvic irradiation should not be a contraindication to kidney transplant. (Copyright © 2024. Published by Elsevier Masson SAS.)
Databáze:	MEDLINE
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