Renal Auto-Transplant as a Definitive Treatment for Nutcracker Syndrome: A Multi-Center Retrospective Study.

Nutcracker Syndrome is a rare condition that involves mechanical compression of the left renal vein leading to chronic and debilitating left flank pain. The etiology of the pain is frequently misdiagnosed, and patients usually require long-term opioid use to manage their pain. Multiple therapeutic options for Nutcracker Syndrome have been described in the literature but the reports are limited by small numbers of patients, and the lack of convincing data demonstrating consistently improved outcomes. Here we report the largest series to date of patients undergoing renal auto-transplantation for the treatment of Nutcracker Syndrome. We performed a multi-center retrospective cohort review of patients 105 patients with Nutcracker Syndrome who underwent renal auto-transplantation as a primary or salvage therapy. During the overall study period, 93.1% of patients treated with auto-transplantation had durable, complete flank pain relief at 12 months with both open and robotic surgical approach. Following auto-transplantation, a statistically significant reduction in percentage of patients using opioids from 48.6 to 17.0% was demonstrated at 12 months. In those patients using opioids prior to auto-transplantation, a statistically significant decrease in Morphine Milligram Equivalents (MME) was demonstrated from an alarming 68.9±15.0 per day to 25.0±11.02 MME per day. Our findings suggest renal auto-transplantation, as a primary treatment or salvage treatment, in patients with Nutcracker Syndrome provides durable pain relief and a marked decrease in chronic opioid use regardless of surgical approach.

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