Simultaneous ipsilateral nephrectomy during kidney transplantation in autosomal dominant polycystic kidney disease: a matched pair analysis of 193 consecutive cases

Abstract

Background In end-stage renal transplant recipients with autosomal-dominant polycystic kidney disease (ADPKD), the imperative, optimal timing, and technique of native nephrectomy remains under discussion. The Freiburg Transplant Center routinely performs a simultaneous ipsilateral nephrectomy. Methods From April 1998 to May 2017, we retrospectively analyzed 193 consecutive ADPKD recipients, receiving per protocol simultaneous ipsilateral nephrectomy and compared morbidity, mortality, and outcome with 193 non-ADPKD recipients of a matched pair control. Results The incidence of surgical complications was similar with respect to severe medical, surgical, urological, vascular, and wound-related complications as well as reoperation rates and 30-day mortality. Intraoperative blood transfusions were required more often in the ADPKD (22.8%) compared with the control group (6.7%; p < 0.0001). Early postoperative urinary tract infections occurred more frequent (ADPKD 40.4%/control 29.0%; p = 0.0246). Time of surgery was prolonged by 30 min (ADPKD 169 min; 95%CI 159.8-175.6 min/control 139 min; 95%CI 131.4-145.0 min; p < 0.0001). One-year patient (ADPKD 96.4%/control 95.8%; p = 0.6537) and death-censored graft survival (ADPKD 94.8%/control 93.7%; p = 0.5479) were comparable between both groups. Conclusions With respect to morbidity and mortality, per protocol, simultaneous native nephrectomy is a safe procedure. Especially in asymptomatic ADPKD KTx recipients, the number of total operations can be reduced and residual diuresis preserved up until transplantation. In living donation, even preemptive transplantation is possible.

The Need for Routine Native Nephrectomy in the Workup for Kidney Transplantation in Autosomal Dominant Polycystic Kidney Disease Patients

“…Second, a combined nephrectomy and transplantation procedure can be performed to reduce the number of surgeries [ 16 , 22 , 23 , 24 ]. Abrol et al analyzed in 148 ADPKD patients whether a combined laparoscopic bilateral nephrectomy and kidney transplantation is safe compared to kidney transplantation alone.…”

Surgical Management of Autosomal Dominant Polycystic Kidney Disease: Principles and Current Practice

“…23 Simultaneous unilateral or bilateral native nephrectomy during the RT is being performed in some centres with no extra morbidity and mortality, which is done to reduce two separate operations and hospital stays. 24,25 Mayo Clinic in the USA has published a classification based on imaging criteria, TKV adjusted for height (ht/ TKV), which may be helpful in determining the need for nephrectomy pre-transplantation. 26 However, there is no professional consensus regarding the timing (pre-/ post-transplant), approach (open vs. laparoscopic), unilateral vs. bilateral and simultaneous nephrectomy and RT.…”

Simultaneous kidney transplantation and ipsilateral native nephrectomy in patients with autosomal dominant polycystic kidney disease

“…The latter KT strategy is now an important issue in the literature representing a prominent indication of KTIN in patients with ADPKD, especially with the living donor KT. In regards to the asymptomatic patients who have a possibility of accessing preemptive KT, the number of surgeries can be reduced and the residual kidney functions and diuresis can be preserved until the time of KT surgery[ 4 ].…”