Abstract
BackgroundThe indication to bilateral nephrectomy in patients with autosomal dominant polycystic kidney scheduled for kidney transplantation is controversial. Indeed, the progressive enlargement of cysts may increase the risk of complications and the need for nephrectomy. However, very few studies investigated the change in kidney volume after kidney transplantation.Material and methodsIn this prospective cohort study, the change in native kidney volume in polycystic patients was evaluated with magnetic resonance imaging. Forty patients were included in the study. Kidney diameters and total kidney volume were evaluated with magnetic resonance imaging in patients who underwent simultaneous nephrectomy and kidney transplantation and in patients with kidney transplant alone, before transplantation and 1 year after transplantation.ResultsThere was a significant reduction of kidney volume after transplantation, with a mean degree of kidney diameters reduction varying from 12.24% to 14.43%. Mean total kidney volume of the 55 kidney considered in the analysis significantly reduced from 1617.94 ± 833.42 ml to 1381.42 ± 1005.73 ml (P<0.05), with a mean rate of 16.44% of volume decrease. More than 80% of patients had a volume reduction in both groups.ConclusionsPolycystic kidneys volume significantly reduces after kidney transplantation, and this would reduce the need for prophylactic bilateral nephrectomy in asymptomatic patients.
Highlights
Autosomal dominant polycystic kidney disease (ADPKD) is a life-threatening genetic disorder characterized by the presence of fluid-filled cysts in various organs, primarily in the kidneys
There was a significant reduction of kidney volume after transplantation, with a mean degree of kidney diameters reduction varying from 12.24% to 14.43%
Mean total kidney volume of the 55 kidney considered in the analysis significantly reduced from 1617.94 ± 833.42 ml to 1381.42 ± 1005.73 ml (P
Summary
Autosomal dominant polycystic kidney disease (ADPKD) is a life-threatening genetic disorder characterized by the presence of fluid-filled cysts in various organs, primarily in the kidneys. While native nephrectomy is clearly indicated in symptomatic patients (cyst bleeding, infection, cancer, early satiety), the indications for and timing of nephrectomy in ADPKD asymptomatic patients remains controversial, especially for those undergoing renal transplantation [11]. Bilateral nephrectomy with concurrent kidney transplantation has been suggested to reduce the incidence of post-transplant complications related to the retained kidney, such as bleeding, recurrent infections, and cancer. This procedure may be well tolerated with a high patient contentment, bilateral nephrectomy is associated with an increased risk of post-transplant complications [15,16,17,18,19,20]. Very few studies investigated the change in kidney volume after kidney transplantation
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