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

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 nephrectomieswere performed at our institution. Of these, 29 procedures wereperformed within 1 month of the transplant and were thereforeomitted from analysis. Overall, the results of 44 ECAN and 23ICAN were reviewed.Results: The mean operative times were 110.9 versus 130.4 minfor ICAN versus ECAN (p = 0.02) and the estimated blood losswas 226 mL for ICAN versus 483 mL for ECAN (p = 0.004).Intraoperative and postoperative complications were low usingeither technique and differences were not statistically significant.Overall, the preoperative to postoperative change in the percentageof panel reactive antibody was +2.1% for ICAN versus +1.2% forECAN (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 wasalso 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 timesand less blood loss versus the extracapsular approach. As well, thisoperative approach does not appear to affect allosensitization andthe ability to re-transplant patients.