Simultaneous Bilateral Native Nephrectomy and Living Donor Renal Transplantation are Successful for Polycystic Kidney Disease: The University of Maryland Experience

Abstract

Patients with autosomal dominant polycystic kidney disease have significant morbidity due to large kidney size and the resultant compression of adjacent organs. Surgical extirpation is limited to the most severe cases due to the risk of complications. Typically surgical extirpation of autosomal dominant polycystic kidney disease kidneys and renal transplantation are performed in staged fashion. The additive risks of these 2 procedures have been a barrier to a simultaneous surgical approach. The risks include transplant compromise due to cyst rupture, bleeding, adjacent organ injury and anti-HLA antibody sensitization from transfusion in cases of pretransplant nephrectomy. We reviewed the results of and graft survival data on bilateral nephrectomy for autosomal dominant polycystic kidney disease with simultaneous live donor renal transplantation. From August 2003 to November 2007, 20 sets of kidneys were removed in patients with autosomal dominant polycystic kidney disease, followed by simultaneous live donor transplantation. We retrospectively reviewed the outcomes in terms of surgical time, complications, length of stay, transfusion rate and transplant kidney status. A total of 20 sets of kidneys were removed and these patients then underwent immediate live donor renal transplantation. Mean operative time was 190 minutes for the bilateral nephrectomy portion alone with an average estimated blood loss of 723 cc. Complications were rare and well tolerated. Mean hospital stay was 7.2 days for this procedure. Graft survival was 100% and all patients reported relief of symptoms. Bilateral nephrectomy and immediate transplantation in patients with autosomal dominant polycystic kidney disease can be done with minimal morbidity. Preliminary studies show that patients may have significant improvement in quality of life from this procedure and graft viability is not compromised.