Native Nephrectomy before and after Renal Transplantation in Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Abstract

The aim of this study was 1) to evaluate and compare pre-, peri-, and post-operative data of Autosomal Dominant Polycystic Kidney Disease (ADPKD) patients undergoing native nephrectomy (NN) either before or after renal transplantation and 2) to identify advantages of optimal surgical timing, postoperative outcomes, and economical aspects in a tertiary transplant centre. This retrospective analysis included 121 patients divided into two groups—group 1: patients who underwent NN prior to receiving a kidney transplant (n = 89) and group 2: patients who underwent NN post-transplant (n = 32). Data analysis was performed according to demographic patient details, surgical indication, laboratory parameters, perioperative complications, underlying pathology, and associated mortality. There was no significant difference in patient demographics between the groups, however right-sided nephrectomy was performed predominantly within group 1. The main indication in both groups undergoing a nephrectomy was pain. Patients among group 2 had no postoperative kidney failure and a significantly shorter hospital stay. Higher rates of more severe complications were observed in group 1, even though this was not statistically significant. Even though the differences between both groups were substantial, the time of NN prior or post-transplant does not seem to affect short-term and long-term transplantation outcomes. Retroperitoneal NN remains a low risk treatment option in patients with symptomatic ADPKD and can be performed either pre- or post-kidney transplantation depending on patients’ symptom severity.

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

“…Our finding could have an important clinical implication because prophylactic nephrectomy still remains controversial in the peritransplantation period of patients with ADPKD. 9 The indication such prophylactic procedure must consider (i) surgical complication rate, 24 , 25 which is, at least in part, influenced by the local operator experience 26 ; (ii) cyst infection incidence after transplantation (in our cohort, most of kidney transplant patients with a history of cyst infection did not experience cyst infection after a median follow-up of 4 years); and (iii) the fact that despite prophylactic unilateral nephrectomy for cyst infection pretransplantation recurrence, cyst infection could still occur in the contralateral native kidney after transplantation as shown in 1 patient in our study. Renal cyst infection is a rare event after renal transplantation even in patients with a history of cyst infection, and so, prophylactic pretransplantation nephrectomy should be reserved only for patients with frequent renal cyst infection recurrence or life-threatening cyst infection.…”

Hand‐assisted laparoscopic bilateral native nephrectomy for autosomal dominant polycystic kidney disease post‐renal transplant

“…ADPKD is the most inherited kidney disease and common cause of end stage renal disease leading to dialysis or transplant in 50% of cases 1,2 . Approximately 20% of these patients will require NN due to recurrent infections, nephrolithiasis, bleeding, pain, and gastrointestinal symptoms related to size or imaging alterations of cystic lesions 3,4 . Surgical approaches vary with the open approach most frequently used.…”

Donor-Derived Cell-Free DNA in Kidney Transplantation as a Potential Rejection Biomarker: A Systematic Literature Review

“…The indication for KTx is end-stage kidney disease, which diabetes, high blood pressure, glomerulonephritis, polycystic kidney disease, and other diseases can lead to [ 2 , 3 , 4 , 5 ].…”