PD45-08 INDICATIONS FOR AND TECHNIQUES OF NATIVE NEPHRECTOMY IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Abstract

You have accessJournal of UrologyRenal Transplantation & Vascular Surgery II (PD45)1 Sep 2021PD45-08 INDICATIONS FOR AND TECHNIQUES OF NATIVE NEPHRECTOMY IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE Usman Haroon, Torath Ameen, Rhana Zakri, and Jonathon Olsburgh Usman HaroonUsman Haroon More articles by this author , Torath AmeenTorath Ameen More articles by this author , Rhana ZakriRhana Zakri More articles by this author , and Jonathon OlsburghJonathon Olsburgh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002059.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We review the clinical indications, timing and surgical techniques for native nephrectomy (NN), together with the associated pathological findings in transplant patients with autosomal dominant polycystic kidney disease (ADPKD) at our institute over a period of 20 years. METHODS: A retrospective review of patients with ADPKD who had both kidney transplantation and NN was performed. NN was performed via a midline or rooftop open incision or hand assisted laparoscopic nephrectomy with an 8 to 10cm infra-umbilical incision. RESULTS: 348 kidney transplants were performed for ADPKD from 1998 to 2018; 184 (52.9%) were male and 89 (55%) were deceased donor transplants. NN was performed on 93 (26%) patients of whom 51 (54%) were male. Mean age at time of NN was 49±9 yrs; significantly younger than age at transplantation 52±12 (p=0.043). Unilateral NN was performed in 37 (39%) patients of whom 11 (30%) went on to have a staged contralateral NN. NN timing was pretransplant (n=47, 50.5%), simultaneous (n=3, 3.3%) and post-transplant (n=43, 46.3%). Indication for NN was pain (n=36, 38.7%), infections (n=33, 35.4%), haematuria (n=11, 11.8%), space (n=4, 4.3%) and tumour suspicion (n=3, 3.3%). Histology revealed renal cell carcinoma in 6 specimens from 4 (4.3%) patients and benign tumours in 11 specimens. Benign findings were from smaller (22.4±5 cm) kidneys compared to malignant (24.2±4 cm); however this was not significant (p=0.28). NNs were performed via open surgery in 44 (47.3%) and laparoscopic-assisted in 49 (52.7%) patient. The length of hospital stay post-NN was significantly longer with open compared with laparoscopic techniques (12±6 v 5±5 days; p=0.003). NN did not influence patient survival or graft survival when compared to non-NN ADPKD patients (p=0.17 and p=0.54 respectively). CONCLUSIONS: In our experience, 26% of ADPKD patients required NN that was approximately equally performed pre and posttransplant. There has been a shift from bilateral to unilateral NN in ADPKD. Hand-assisted laparoscopic NN is feasible and safe in these large kidneys with decreased morbidity and shorter length of hospital stay than open surgery. Source of Funding: Nill © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e745-e745 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Usman Haroon More articles by this author Torath Ameen More articles by this author Rhana Zakri More articles by this author Jonathon Olsburgh More articles by this author Expand All Advertisement Loading ...