Kidney Transplantation with Concomitant Unilateral Nephrectomy: A Matched-Pair Analysis on Complications and Outcome

Drognitz, Oliver; Kirste, Günter; Schramm, Inga; Assmann, Angelika; Pöhl, Martin; Göbel, Heike; Thomusch, Oliver; Hopt, Ulrich T.; Pisarski, Przemyslaw

doi:10.1097/01.tp.0000203319.93328.27

Cited by 21 publications

(15 citation statements)

References 18 publications

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“…However, these advantages are counterbalanced by the potential for more postoperative complications such as bleeding and infection [16,17]. This may also have an adverse affect on patient as well as graft survival rates after transplantation, but some studies have refuted this observation [7,14,18,19].…”

Section: Discussionmentioning

confidence: 99%

Native nephrectomy for autosomal dominant polycystic kidney disease: before or after kidney transplantation?

et al. 2010

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Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The indications and timing of native nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is controversial, especially for those undergoing renal transplantation. Post‐transplant unilateral native nephrectomy appears to be the preferred intervention compared to pre‐transplant native nephrectomy. There seems to be substantial additive risk to bilateral over unilateral nephrectomy, especially prior to transplantation. Pre‐transplant native nephrectomy should only be carried out when there are clear indications such as massive size preventing allograft placement, severe pain, early satiety, recurrent bleeding and infections, or suspected malignancy. OBJECTIVE To analyse indications, timing and outcomes of native nephrectomy in autosomal dominant polycystic kidney disease (ADPKD) patients listed for kidney transplantation. PATIENTS AND METHODS A retrospective analysis of all ADPKD patients who had a native nephrectomy prior to or following transplantation between January 2003 and December 2009 at a single centre, including those undergoing the sandwich technique (removal of the most severely affected native kidney prior to transplantation, and the other afterwards), was undertaken. RESULTS There were 35 individuals in our cohort (M : F = 16 : 19), with a median age of 51.5 years (range 43–65). Twenty patients were in the pre‐transplant nephrectomy group, 12 in the post‐transplant group, and three underwent the sandwich technique. Indications for nephrectomy varied but were most commonly pain/discomfort, space for transplantation, ongoing haematuria, recurrent infections, and gastrointestinal pressure symptoms (early satiety). Seven individuals in the pre‐transplant group and three in the post‐transplant group required critical care admission after nephrectomy. Transient renal graft dysfunction occurred in two post‐transplant bilateral nephrectomy patients. Two patients in the bilateral nephrectomy pre‐transplant group and one in the bilateral nephrectomy post‐transplant group died in the immediate post‐operative period. No complications were noted in the sandwich technique group. CONCLUSION Native nephrectomy in ADPKD is a major undertaking associated with significant morbidity especially in the pre‐transplant group. Post‐transplant unilateral nephrectomy appears to be the safest approach with fewest complications.

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Section: Discussionmentioning

confidence: 99%

Native nephrectomy for autosomal dominant polycystic kidney disease: before or after kidney transplantation?

et al. 2010

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“…Thus, bilateral nephrectomy simultaneous to transplantation would have the theoretical advantage of reducing the overall number of operative procedures thereby minimizing surgery injury. However, concern has been raised as to whether patients undergoing KT with adjuvant bilateral nephrectomy are at an increased risk for postoperative complications, such as bleeding and infection, which might deteriorate patient and graft survival rates after KT [16] . From the experience of our center, CBN during KT significantly relieved the patients from persistent arterial hypertension and urinary tract infection, although it might increase operation time, blood transfusion and the incidence of adjacent organ injury.…”

Section: Discussionmentioning

confidence: 99%

Kidney Transplant for Autosomal Dominant Polycystic Kidney Disease: The Superiority of Concurrent Bilateral Nephrectomy

Song

Zheng²,

Mo³

et al. 2011

Urol Int

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Objective: To assess the transplant outcome of patients who underwent concurrent bilateral nephrectomies (CBN) during kidney transplantation (KT) owing to autosomal dominant polycystic kidney disease (ADPKD). Methods: The study included 67 ADPKD patients, 4 of whom were excluded, and the rest, 63 patients, were divided into two groups: KT with CBN (group A, n = 31) and KT without CBN (group B, n = 32). Demographic factors, transplant-related factors, posttransplant complications and patient survival were compared. Results: There was no statistical difference in demographic or transplant-related factors between the two groups, though group A patients required more operation time (300 ± 30.85 vs. 120 ± 20.78 min, p < 0.01), needed more blood transfusion (4.31 ± 1.05 vs. 1.35 ± 0.23 U, p < 0.01) and had more adjacent organ injury during operation (22.58 vs. 0%, p < 0.01) compared with group B. However, group A patients had better relief from arterial hypertension persistence and lower urinary tract infection postoperation than group B (16/24 vs. 22/24, 6.45 vs. 31.25%, p < 0.05). Patient survival in the two groups was similar at 1 and 5 years (p > 0.05). Conclusion: CBN could be safely performed during KT for patients with ADPKD. The patients could benefit from reduction of the operative procedures, better relief from arterial hypertension persistence and lower urinary tract infection posttransplantation.

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“…Compared with ABO‐compatible living donor kidney transplantation, there is no difference in surgical techniques and spectrum of surgical complications (as classified in Table ) . However, one study reported a nonsignificant trend to a higher incidence (25%) of immediate postoperative bleeding and a more frequent surgical revision rate .…”

Section: Surgical Complicationsmentioning

confidence: 99%

An update on ABO-incompatible kidney transplantation

et al. 2014

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SummaryABO-incompatible kidney transplantation is nowadays a well-established procedure to expand living donor transplantation to blood group incompatible donor/ recipient constellations. In the last two decades, transplantation protocols evolved to more specific isohaemagglutinin elimination techniques and established competent antirejection protection protocols without the need of splenectomy. ABOi kidney transplantation associated accommodation despite isohaemagglutinin reappearance, C4d positivity of peritubular capillaries as well as the increased incidence of bleeding complications is currently under intense investigation. However, most recent data show excellent graft survival rates equivalent to ABOcompatible kidney transplantation outcome.

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Kidney Transplantation with Concomitant Unilateral Nephrectomy: A Matched-Pair Analysis on Complications and Outcome

Abstract: Kidney transplantation with concomitant unilateral nephrectomy has no negative impact on patient or graft survival and is associated with a reasonable morbidity rate.

Cited by 21 publications

References 18 publications

Native nephrectomy for autosomal dominant polycystic kidney disease: before or after kidney transplantation?

Native nephrectomy for autosomal dominant polycystic kidney disease: before or after kidney transplantation?

Kidney Transplant for Autosomal Dominant Polycystic Kidney Disease: The Superiority of Concurrent Bilateral Nephrectomy

An update on ABO-incompatible kidney transplantation

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