End Stage Polycystic Kidney Disease: Indications and Timing of Native Nephrectomy Relative to Kidney Transplantation

Abstract

Unilateral or bilateral nephrectomy for PCKD at transplantation is safe in terms of postoperative patient morbidity and graft function. We perform concomitant native nephrectomy when indicated, preferably in recipients of living donor kidney transplants.

Tailoring the ‘Perfect Fit’ for Renal Transplant Recipients with End-stage Polycystic Kidney Disease: Indications and Timing of Native Nephrectomy

“…Right-sided nephrectomy and renal allograft placement was performed unless there was a symptomatic left kidney. Operative time was found to be extended by less than 1 h, in contrast to bilateral nephrectomy performed by transperitoneal incision, which added about 160-190 min according to other studies (9,14). According to the authors' experience this approach can be safely performed without endangering patient or graft survival.…”

“…Fuller et al performed a retrospective study that compared the outcomes of pre-transplant (group 1), simultaneous (group 2) and post-transplant (group 3) NN in patients with ADPKD (9). All three groups showed similar results in terms of the safety and success of the procedure.…”

“…Nonetheless, since it has been established that renal transplantation is the treatment of choice for ESRD and that longer dialysis time negatively impacts survival of both patients and graft, it is important to perform renal transplantation as early as possible (23,24). In cases that are provided with the option of living-donor transplantation, the performance of the simultaneous procedure could be of benefit (3,9,(11)(12)(13)25).…”

“…Moreover, when the principal indication for NN is the creation of space for the renal allograft, various studies highlight the safety of the simultaneous approach of either unilateral or bilateral nephrectomy (3,9,(11)(12)(13)25). This approach is also advantageous as it does not impair graft or patient survival and spares the need for separate pretransplant removal of the native kidney, with all the dangers and post-operative complications that any procedure carries.…”

“…This approach is also advantageous as it does not impair graft or patient survival and spares the need for separate pretransplant removal of the native kidney, with all the dangers and post-operative complications that any procedure carries. Furthermore, it enables transplantation to be pre-emptive, especially in the context of a well-planned living-donor transplantation (3,9,11,13). Another parameter that should be taken into account is the degree of patient satisfaction.…”