Abstract
BackgroundIn 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.MethodsFrom 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.ResultsThe 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.ConclusionsWith 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.
Highlights
The risk of end-stage renal disease (ESRD) in autosomal-dominant polycystic kidney disease (ADPKD) patients is age-related
In the remaining group of 1524 patients, we identified 193 recipients with ADPKD receiving simultaneous ipsilateral nephrectomy during renal transplant procedure (ADPKD group)
The operative time in ADPKD patients was 30 min longer on average (ADPKD 169 min; 95% confidence interval (CI) 159.8–175.6 min vs. control 139 min; 95% CI 131.4–145.0 min; p < 0.0001)
Summary
The risk of end-stage renal disease (ESRD) in ADPKD patients is age-related. Concerns about placing renal graft function at risk by adding simultaneous nephrectomy to the procedure in asymptomatic recipients or by post-transplant ipsilateral nephrectomy for post-KTx symptoms caused by the remaining kidney have to be addressed. The question remains: Are we putting patients at risk for surgical complications by the nephrectomy and a prolonged operation time when pursuing a per protocol simultaneous approach. 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. 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
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