Modification of the nephrometric scale for assessing the complexity of a transplanted kidney resection

Introduction. Kidney transplantation is the most effective method of treating patients with end-stage chronic renal failure. Recipients of donor kidneys have a significantly increased risk of developing renal cell carcinoma of the graft, while its surgical treatment is very difficult due to the pronounced differences in the anatomy of the transplant from native kidneys. Currently, there is no nephrometric scoring system for assessing the complexity of resection and the risk of complications adapted to the transplanted kidney, which was the reason for the development of a nephrometric scale modified for the kidney transplant. Materials and methods. A search of publications was performed in the PubMed, Cyberlennika, eLibrary databases using the keywords: «transplanted kidney», «resection», «renal cell carcinoma», «nephrometric scale». 59 publications were selected and included in this review. The clinical material is based on the analysis of the experience of the urology department of City Clinical Hospital No. 52, where 31 patients with renal cell carcinoma of the transplanted kidney were examined and operated on. Results. An overview of existing nephrometric scales is given, the R.E.N.A.L. and PADUA (Preoperative Aspects and Dimensions Used for an Anatomical classification of renal tumors) scales are described in detail, the features of surgical treatment of renal cell carcinoma of the transplanted kidney and the developed modified R.E.N.A.L.-TK scale are presented. A clinical case of successful laparoscopic resection of the transplanted kidney with a preliminary assessment of the complexity of the operation using the modified R.E.N.A.L.-TK scale is presented. Conclusions. Organ-preserving surgical treatment of cancer of the transplanted kidney has its own pronounced distinctive features compared to the corresponding treatment of the native kidney, which makes it a more complex operation with a different characteristic spectrum of intraand postoperative complications. The use of nephrometric scales adapted to the specifics of resection of the transplanted kidney can increase the effectiveness of their use and will contribute to improving treatment outcomes.