Transplantation in Autosomal Dominant Polycystic Kidney Disease without Nephrectomy

Abstract

Some transplantation centers still suggest nephrectomy in patients with autosomal dominant poycystic kidney disease (ADPKD) before kidney transplantation at least in selected cases. We wanted to learn whether prior nephrectomy is beneficial. The outcome of kidney transplantation in 47 consecutive ADPKD patients without prior nephrectomy was compared with that in matched controls with respect to complications of ADPKD. Although ADPKD patients were older than controls (mean, 50.1 vs. 40.3 years), there was no statistically significant difference in 1- and 5-year allograft survival between ADPKD patients and controls: 76.6 and 68.0%, respectively, in ADPKD patients, and 83.9 and 56.3% in controls. After a mean follow-up of 66.5 months 3 patients with ADPKD had cyst infections and were managed with antibiotics. Two patients had episodes of hematuria; neither required invasive therapy. There was no renal malignancy and clinical sign of urolithiasis in any patient. No posttransplantation nephrectomy was required. With only few indications remaining, there is no rationale for routine pretransplantation nephrectomy in patients with ADPKD.

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

“…However, with the development of intensive care and surgical techniques, the incidence of severe posttransplant complications was markedly decreased. Therefore, routine pretransplant native nephrectomy for ADPKD is not beneficial nowadays [11][12][13] . Some other centers suggested a 'sandwich' technique which recommended that patients were primarily scheduled for the removal of the more seriously affected native kidney before transplantation, and the remaining one thereafter [14] .…”

Laparoscopic pretransplant nephrectomy with morcellation in autosomic-dominant polycystic kidney disease patients with end-stage renal disease

“…Several authors concluded that in patients with ADPKD, nephrectomy is not indicated as a routine pretransplant procedure, having no advantages in terms of complications and survival over transplantation with both native kidneys intact [12][13][14][15]. On the contrary, some authors [16,17] suggest that the native polycystic kidneys are at risk of infectious and hemorrhagic complications after grafting, in addition to patient's discomfort and technical difficulties with graft placement.…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…On the other hand, outcomes among 47 consecutive ADPKD patients without pretransplant nephrectomy were compared to those of 47 matched, non-ADPKD controls (880). There were no differences in 1-and 5-year graft survival rates.…”

“…Only three ADPKD patients had cyst infections and two had episodes of hematuria, but in neither case was invasive intervention required. These authors concluded that routine pretransplant nephrectomy is not required for most patients with ADPKD (880). In the absence of data to the contrary, it seems reasonable to reserve pretransplant nephrectomy for ADPKD patients who have recurrent, symptomatic, cyst-related complications.…”