Simultaneous Renal Transplantation and Native Nephrectomy in Patients With Autosomal-Dominant Polycystic Kidney Disease

Abstract

Our objective was to study the influence on transplant outcome of unilateral native nephrectomy of massively enlarged kidneys at the time of renal transplantation among patients with end-stage renal disease owing to autosomal-dominant polycystic kidney disease (ADPKD). Patients and Methods. We studied 159 renal transplants in patients with ADPKD divided into two groups according to the need to perform a unilateral native nephrectomy owing to enlarged kidneys (Nϩ; n ϭ 143) versus those not (N0; n ϭ 16) needing this procedure. Parameters related to the donors, grafts, recipients, and operative data were correlated with short-and long-term outcomes. The groups were homogeneous in terms of recipient and donor ages, genders, HLA compatibilities, and length of pretransplant dialysis. Results. When no nephrectomy was needed surgery length was shorter (N0, 3.01 vs. Nϩ, 4.23 hours; P Ͻ .001), less intraoperative crystalloids were infused (N0, 1.84 vs. Nϩ, 2.76 L; P Ͻ .001), and less plasma (N0, 2.07 vs. Nϩ, 2.93 U; P Ͻ .05), or blood (N0, 1.05 vs. Nϩ, 1.81 U; P Ͻ .05) transfusions were required. Hospital stay was similar (N0, 12.70 vs Nϩ, 16.50 days; P not significant [NS]). There was only one urologic complication in the nephrectomy group. There were no differences (P ϭ NS) in rates of delayed graft function (N0, 19.9%; Nϩ, 12.5%), acute rejections (N0, 25.5%; N0, 33.3%), chronic allograft dysfunction (N0, 15.8%; Nϩ, 28.6%). Graft function at 1 month as well as 1 and 5 years were comparable. Patient and graft survivals were similar at 1 and 5 years. There were no differences in the causes of graft loss or patient death. Conclusion. In patients with ADPKD native nephrectomy of massively enlarged kidneys may be safely performed during the transplant procedure with no repercussions on the length of hospital stay, graft short-and long-term function and patient survival. However the procedure eads to a longer operative time and greater need for fluids and blood products.

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

“…Nunes et al performed a retrospective analysis of 159 living and deceased donor renal transplantations in individuals with ADPKD (11). They compared the results of renal transplant recipients that underwent unilateral NN due to enlarged kidneys (group 1, n=143) and those in whom this procedure was not necessary (group 2, n=16).…”

“…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.…”

“…According to the retrospective analysis of these studies' outcomes, the estimated percentage of the patients with in vivo 31: 307-312 (2017) 310 (20) + ADPKD that needed NN was relatively low (around 20%) and the majority of complications that led to NN occurred during the post-transplant period (11,(15)(16)(17). This evidence indicates that there may be no need to burden patients with an extra procedure either prior to or concomitant with renal transplantation, except in symptomatic cases (10,21).…”