Simultaneous Native Nephrectomy and Kidney Transplantation in Patients With Autosomal Dominant Polycystic Kidney Disease

Veroux, Massimiliano; Zerbo, D.; Basile, G.; Gozzo, Cecilia; Sinagra, N.; Giaquinta, Alessia; Sanfiorenzo, Angelo

doi:10.1371/journal.pone.0155481

Cited by 34 publications

(37 citation statements)

References 36 publications

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“…Some studies suggest that simultaneous nephrectomy and kidney transplant is preferable to pretransplant nephrectomy in asymptomatic patients with ADPKD, and nephrectomy should be requested only if massive kidney size prevents graft placement. 15,16 We should note that no patients in our control group underwent nephrectomy. The indications for native nephrectomy in non-ADPKD patients include uncontrolled hypertension, Goodpasture syndrome, recurrent or chronic pyelonephritis, structural urinary tract abnormalities, urolithiasis, and massive proteinuria.…”

Section: Discussionmentioning

confidence: 95%

Untitled

Barbouch

Hajji²,

Hedri³

et al. 2017

Exp Clin Transplant

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Objectives: Autosomal dominant polycystic kidney disease is a common cause of end-stage renal disease and a common indication for renal transplant. This study was undertaken to evaluate the demographics, outcomes, and complications of renal transplant in patients with autosomal dominant polycystic kidney disease compared with other nephropathies. Materials and Methods: In a retrospective case-control design, we reviewed the records of 7 patients with autosomal dominant polycystic kidney disease from a total of 701 renal transplant patients over a 30-year period (1986-2016). For each patient, a matched control was selected based on sex, age, year of transplant, and type of kidney donor. We excluded patients who underwent kidney transplant abroad and those with a follow-up period of less than 2 years. Results: The number of patients with autosomal dominant polycystic kidney disease requiring transplant at our center was estimated at 0.23 per year, and the condition represented 1.57% of initial nephropathy causes. The mean patient age at transplant was 50.8 ± 8.05 years. There were 5 male and 2 female patients in the case group, with a male-to-female ratio of 2.5. The source of the graft was predominantly a living related donor (5/7). Four patients had extrarenal manifestations, the most common of which were liver cysts (3 patients). Rejection occurred in a single study patient (14.2%) and in 4 control patients (57.1%; P = .51). Two patients did not develop any complications. Complications noted after transplant included infection (3/7 cases vs 2/7 controls; P = .67) and cerebrovascular accidents (2/7 cases vs 0/7 controls). Conclusions:Further studies with longer follow-up and greater numbers of patients are needed to compare more precisely the complications and results of transplant between patients with autosomal dominant polycystic kidney disease and other kidney transplant recipients.

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Section: Discussionmentioning

confidence: 95%

Untitled

Barbouch

Hajji²,

Hedri³

et al. 2017

Exp Clin Transplant

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“…Therefore, decisions usually are based on the subjective evaluation and experience of the attending surgeon or as in this study by protocol. Focusing on surgical complications, a benefit favoring a certain time-point (pre-or post-transplant) did not emerge [15,18,19]. Of note, residual diuresis and pre-transplant hemoglobin are significantly lower in patients receiving pretransplant nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous ipsilateral nephrectomy during kidney transplantation in autosomal dominant polycystic kidney disease: a matched pair analysis of 193 consecutive cases

Jänigen

Hempel

Holzner

et al. 2020

Langenbecks Arch Surg

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Background 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. The Freiburg Transplant Center routinely performs a simultaneous ipsilateral nephrectomy. 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. Results The 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. Conclusions With 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.

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“…Older studies from large international registries reported an incidence of FD among patients on dialysis ranging between 0.016% [ 19 ] and 0.018% [ 29 , 30 ]. However, many recent studies demonstrated that the incidence of GLA mutations in patients with ESRD may be significantly higher [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Kidney transplant recipients, aged >18 years, who received a graft between 2000 and 2017, with a functioning graft followed at the Organ Transplant Unit of the University Hospital of Catania, Italy, were included in this study. All patients underwent single kidney transplantation with standard procedure and were on a triple immunosuppressive regimen, as previously described [ 19 ]. Patients were invited to participate in the study during the regular follow-up visits, and all patients gave written informed consent.…”

Section: Methodsmentioning

confidence: 99%

Screening for Fabry Disease in Kidney Transplant Recipients: Experience of a Multidisciplinary Team

et al. 2020

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Fabry disease (FD) is a rare cause of end-stage renal disease requiring kidney transplantation. Data on the incidence of unrecognized FD in kidney transplant recipients are scarce and probably underestimated. This study evaluated the incidence of FD in a population of kidney recipients, with a particular focus of the multidisciplinary approach for an early clinical assessment and therapeutic approach. Two hundred sixty-five kidney transplant recipients were screened with a genetic analysis for α-galactosidase A (GLA) mutation, with measurement of α-Gal A enzyme activity and Lyso Gb3 levels. Screening was also extended to relatives of affected patients. Seven patients (2.6%) had a GLA mutation. Two patients had a classic form of FD with Fabry nephropathy. Among the relatives, 15 subjects had a GLA mutation, and two had a Fabry nephropathy. The clinical and diagnostic assessment was completed after a median of 3.2 months, and mean time from diagnosis to treatment was 4.6 months. This study reported a high incidence of unrecognized GLA mutations in kidney transplant recipients. Evaluation and management by a multidisciplinary team allowed for an early diagnosis and treatment, and this would result in a delay in the progression of the disease and, finally, in better long-term outcomes.

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Simultaneous Native Nephrectomy and Kidney Transplantation in Patients With Autosomal Dominant Polycystic Kidney Disease

Cited by 34 publications

References 36 publications

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Simultaneous ipsilateral nephrectomy during kidney transplantation in autosomal dominant polycystic kidney disease: a matched pair analysis of 193 consecutive cases

Screening for Fabry Disease in Kidney Transplant Recipients: Experience of a Multidisciplinary Team

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