Presentation Authors: Molly DeWitt-Foy*, Mohamed Eltemamy, Rathika Ramkumar, Alyssa Crow, Tianming Gao, Alvin Wee, Stuart Flechner, Venkatesh Krishnamurthi, Cleveland, OH
Introduction: Renal autotransplant (RA) may be used in select patients with chronic renal pain after all other means of pain control have been exhausted. Because this procedure is relatively rare, and because the indications and outcomes are subjective, success rates are difficult to assess. We aimed to determine the effectiveness of RA in the management of refractory chronic kidney pain.
Methods: Chart review was completed of all patients who underwent RA at our institution between 2004 and 2018 for an indication of chronic pain. Demographics, medical and surgical history, operative details, and complications were recorded. Patients were mailed an information sheet and those who agreed to participate completed a validated Brief Pain Inventory (BPI) that included assessment of pain and analgesic use. Univariate analysis was performed, and a linear regression model was fit to each univariate model.
Results: A total of 98 patients underwent 114 RA, of which 31 were completed for a primary indication of chronic pain. Pre and postoperative pain scores and medications were assessed via the BPI. The average age at surgery was 34 (range from 16 to 48 years). The mean change in average pain was -3.3 points. There was improvement in the average pain scores after 22 (71%) RA, no change after 6 (19.4%), and worse pain after 3 ( < 1%). Complete discontinuation of opioids was achieved in 21 patients, and 8 patients continued opioid medications at a lower dosage than prior to surgery. Postoperative pain medication information was not available for one patient. On univariate analysis ipsilateral renal surgery and recent renal function were significantly associated with change in mean pain score. The improvement in pain score for patients without a history of prior surgery on the same kidney was 3.31 units better than for those with a history of surgery on the same kidney (SE 1.17, p=0.009). Similarly, a lower creatinine at most recent follow up was associated with greater improvement in average pain score, by 4.02 units per each 1.0 mg/dL difference in creatinine (SE 1.85, p = 0.039). Preoperative psychiatry evaluation, successful preoperative pain block, operative time, gender, age, pain etiology, and use of ureteral stenting were not predictive of an improvement in postoperative pain score.
Conclusions: We describe 31 RA completed at one institution for an indication of refractory chronic severe renal pain. The majority of patients had improvement in pain scores postoperatively, with 70% reporting discontinuation of all opioid medications. Higher postoperative creatinine and history of ipsilateral renal surgery were associated with less improvement in pain.