The perioperative management of simultaneous bilateral nephrectomy with renal transplantation: a case series

Abstract

Purpose Bilateral nephrectomy is performed at times with renal transplantation. Though surgical indications and timing of these two procedures have been described, there are no large case series describing the anesthetic management of these cases. We sought to describe our experience. Methods We performed a historical cohort study on 54 consecutive cases of simultaneous bilateral nephrectomy with renal transplantation at a single, tertiary-care medical centre. Descriptive statistics were used. Results The most common etiology of kidney disease involved was autosomal dominant polycystic kidney disease at 52/54 (96%) cases. All patients received grafts from living donors. An arterial line was placed in 44 (81%) and a central venous catheter in 16 (30%) subjects. At least one vasopressor infusion was used in 44 (81%) cases and 37 (69%) patients required admission to the intensive care unit (ICU). Of this subset, 30 (81%) were admitted for ongoing vasopressor support and six (16%) for hemodynamic monitoring. All patients were extubated in the operating room upon completion of the procedure. Median [interquartile range (IQR)] ICU length of stay (LOS) was 0.9 [0.7–1.4] days and total hospital LOS was 4.4 [4.3–5.4] days. There were no cases of mortality at 30 days or of postoperative dialysis. Conclusions Adult patients undergoing simultaneous bilateral nephrectomy with renal transplantation often developed perioperative hypotension requiring vasopressor infusions and postoperative transfer to the ICU. This is possibly due to a temporary loss of the renin-angiotensin system. Despite this, patients most commonly were transferred to the floor on postoperative day 1 and had successful outcomes with no mortality at 30 days.

The Need for Routine Native Nephrectomy in the Workup for Kidney Transplantation in Autosomal Dominant Polycystic Kidney Disease Patients

“…Second, a combined nephrectomy and transplantation procedure can be performed to reduce the number of surgeries [ 16 , 22 , 23 , 24 ]. Abrol et al analyzed in 148 ADPKD patients whether a combined laparoscopic bilateral nephrectomy and kidney transplantation is safe compared to kidney transplantation alone.…”

Safety and feasibility of synchronous unilateral nephrectomy and contralateral heminephrectomy for extremely severe autosomal dominant polycystic kidney disease: Techniques and outcome

“…Moreover, simultaneous bilateral nephrectomy for particularly large bilateral ADPKD kidneys could cause severe hemodynamic instability in the postoperative period because of the abrupt reduction in renin and angiotensin [ 15 ]. According to the previous studies, 50% to 70% of patients experienced postoperative hypotension, requiring inotropic agents and ICU care [ 18 25 26 ], which is sometimes refractory and persistent [ 27 28 ]. Moreover, considering these patients require dialysis, pre-dialysis hypotension poses a major threat to survival.…”