Mp37-06 attenuated Antihypertensive Requirements in Autosomal Dominant Polycystic Kidney Patients Undergoing Native Nephrectomy With Renal Transplantation: A Contemporary Analysis

Abstract

All active, adult kidney transplant centers listed on the UNOS website were eligible for inclusion (194). Centers were called up to 3 times for survey.RESULTS: 122 centers responded. 49 were willing to evaluate incarcerated individuals (34 public, 15 private), 43 willing to list (30 public, 13 private), and 42 willing to transplant (30 public, 12 private). 14 centers said yes, but on a case-by-case basis only. Reported considerations were type of crime, length of sentence, and likelihood of release. Frequently cited reasons for not treating inmates were: inadequate follow-up (28), insurance/funding (16), transportation (12), medication compliance (9), security (8), patient safety (8), and lack of social support (5). 24 centers refused to disclose their policy or did not have one. Two centers claimed incarceration was a contraindication to kidney transplantation.CONCLUSIONS: As prevalence of ESRD increases in the incarcerated population, barriers to transplant for inmates need to be addressed. A lack of understanding of the contraindications to transplant or a lack of knowledge about the prisoner system on behalf of transplant centers may contribute to these barriers. However, there is likely a component of implicit bias and ethical dilemma. We feel as transplant professionals it is our responsibility to assist vulnerable patients in overcoming barriers to transplantation and work to ensure equitable access to organs, regardless of incarceration status.

Recurrence of renal cell carcinoma after simultaneous radical nephrectomy and cadaver renal transplant

“…In most cases of autosomal dominant polycystic kidney disease, nephrectomy is performed simultaneously with renal transplant to secure the transplant bed, 3,4 and there has been a previous report of incidentalomas. 5 Sultan et al performed radical nephrectomy and renal transplant in 16 patients with renal tumors at the time of transplantation, 10 of whom had renal cell carcinoma.…”

“…In most cases of autosomal dominant polycystic kidney disease, nephrectomy is performed simultaneously with renal transplant to secure the transplant bed, 3,4 and there has been a previous report of incidentalomas 5 . Sultan et al.…”

“…Treatment conversion to mTOR inhibitors is correlated with a low incidence of malignancies and is safe for renal function and graft survival in patients with a cancer history. 4 The use of immune checkpoint inhibitors is another treatment option for renal cancer. However, it might be associated with a high risk of acute rejection.…”