Pretransplant Nephrectomy in Patients With Autosomal Dominant Polycystic Kidney Disease
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).