Pretransplant Nephrectomy in Patients With Autosomal Dominant Polycystic Kidney Disease

https://doi.org/10.1016/j.transproceed.2004.12.115Get rights and content

Abstract

Background

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease and a frequent cause of end-stage renal failure. Transplantation in patients with ADPKD is associated with specific cyst-related problems, especially urinary tract infections (UTI). Although pretransplant nephrectomy has been applied in this group of patients, evidence of the benefits of this strategy is lacking. Therefore, we compared the outcomes and posttransplant complications among patients with or without pretransplant nephrectomy.

Patients and Methods

ADPKD patients (73) transplanted from cadaveric donors were reviewed retrospectively with regard to posttransplant complications and outcomes. The groups either underwent pretransplant unilateral nephrectomy (n = 30) or were transplanted with native kidneys intact (n = 43).

Results

Two patients underwent simultaneous bilateral nephrectomy due to a large size of the polycystic kidneys interfering with the transplant operation. Overall postransplant complications were more frequent in the group without nephrectomy (34% vs 20%); however, the difference was not statistically significant. Most complications were related to cyst infections with 3 deaths (12%) due to lethal septicemia in the group without nephrectomy. No infection-related deaths were noted in the group with pretransplant nephrectomy.

Conclusions

Graft and patient outcomes as well postransplant complications were similar in both groups, independent of previous nephrectomy. It seems that pretransplant unilateral nephrectomy should not be routine and has no advantage over transplantation with both native kidneys intact, although this conclusion is limited by the small number of patients. An Individualized approach should be applied especially when there has been a history of cyst-related infection.

Section snippets

Material and methods

Among 1146 cadaveric kidney transplantations performed in two transplantation centers between 1980 and 2002, 73 patients with ADPKD underwent kidney transplantation from cadaveric donors. Medical data of all patients were obtained from hospital records and ambulatory medical charts. Observation time was 1 year after transplantation. The demographic data are shown in Table 1. Diagnosis of UTI was based on clinical examinations and urine tests particularly with positive urine cultures. Bleeding

Results

Posttransplant complications are listed in Table 2. In group 1, 1 patient required resection of the native and transplanted kidney as the consequence of cyst abscess with involvement of the graft. In those patients who had pretransplant nephrectomy for medical reasons (bleeding into the cyst, abscess, stones), no complications were observed. In group 1, no patient died but five required nephrectomy of the remaining polycystic kidney due to cyst infection (n = 1), urosepsis (n = 3), or

Discussion

ADPKD patients display an increased risk of complications related to the cysts. In the 1970s, bilateral nephrectomy performed prior to transplantation was a common procedure. Major indications for nephrectomy were recurrent cyst infections and UTIs, severe hypertension, bleeding into the cysts, large size of native kidneys limiting space for transplantation, and intractable pain. Raner observed a significant increase in the death rate due to urosepsis with an origin in cysts among patients who

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This research was financed by the State Committee for Scientific Research of Poland (grant 3P05A01122).

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