Incidence, Risk Factors and Outcomes of Kidney and Liver Cyst Infection in Kidney Transplant Recipient With ADPKD

Abstract

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Surgical Management of Autosomal Dominant Polycystic Kidney Disease: Principles and Current Practice

“…Repeated hospitalisation from recurrent cyst infections is an indication for nephrectomy, particularly in patients who are waiting to have an RT because of the risk of life-threatening sepsis post-transplantation in the setting of immunosuppression. 17 , 18 …”

The Presence of Kidney Cyst Infections in Patients With ADPKD After Kidney Transplantation: Need for Urological Analysis?

“…This raises the question about whether patients with ADPKD with a history of cyst infections may benefit from pretransplantation nephrectomy. In the study of Ronsin et al, 3 the risk to develop a new cyst infection in a patient with unilateral nephrectomy and a history of cyst infection was 9.1% versus 12.5% in a patient with a positive history for cyst infection, but without preemptive transplantation nephrectomy. This suggests that preemptive nephrectomy may only lead to a relatively small benefit to reduce the chance for a cyst infection.…”

“…However, until recently, no data has been available to support this hypothesis. 2 Recently, KI Reports published a retrospective study of Ronsin et al 3 that investigated the incidence, risk factors and outcomes of cyst infections in transplanted patients with ADPKD. The authors found that though the incidence of cyst infection after kidney transplantation is low, history of cyst infection before transplantation represents the main risk factor.…”

In Reply to “The Presence of Kidney Cyst Infections in ADPKD Patients After Kidney Transplantation: Need for Urological Analysis?"

“…As they stated, prophylactic nephrectomy did not prevent cyst infection recurrence in the post-transplantation period in our retrospective cohort. 2 Among the 43 patients with a history of cyst infection, 11 had prophylactic unilateral nephrectomy (6 for recurrent cyst infection and 5 for insufficient place for renal allograft) and 32 patients did not receive pre-emptive transplantation nephrectomy. One (1 of 11, 9.1%) patient in the prophylactic unilateral nephrectomy group and 4 (4 of 32, 12.5%) in the group without prophylactic nephrectomy developed a cyst infection after kidney transplantation.…”

“…Finally, cyst infection, also in a transplanted patient, is rarely life-threatening or even severe (1 of 12, 8% in the cyst infection determined by imaging) because their management in recent years has been improved with the use of lipophilic antibiotics for a long duration. 3 Therefore, balancing the surgical risk of prophylactic nephrectomy and the drawbacks mentioned above, do not plead for its implementation in all patients with a history of cyst infection but rather to confine it in the rare cases of frequently relapsing or persistent infection.…”