Simultaneous Renal Transplantation and Native Nephrectomy in Patients with Autosomal-dominant Polycystic Kidney Disease

Unlabelled: Our objective was to study the influence on transplant outcome of unilateral native nephrectomy of massively enlarged kidneys at the time of renal transplantation among patients with end-stage renal disease owing to autosomal-dominant polycystic kidney disease (ADPKD).

Patients And Methods: We studied 159 renal transplants in patients with ADPKD divided into two groups according to the need to perform a unilateral native nephrectomy owing to enlarged kidneys (N+; n = 143) versus those not (N0; n = 16) needing this procedure. Parameters related to the donors, grafts, recipients, and operative data were correlated with short- and long-term outcomes. The groups were homogeneous in terms of recipient and donor ages, genders, HLA compatibilities, and length of pretransplant dialysis.

Results: When no nephrectomy was needed surgery length was shorter (N0, 3.01 vs. N+, 4.23 hours; P < .001), less intraoperative crystalloids were infused (N0, 1.84 vs. N+, 2.76 L; P < .001), and less plasma (N0, 2.07 vs. N+, 2.93 U; P < .05), or blood (N0, 1.05 vs. N+, 1.81 U; P < .05) transfusions were required. Hospital stay was similar (N0, 12.70 vs N+, 16.50 days; P not significant [NS]). There was only one urologic complication in the nephrectomy group. There were no differences (P = NS) in rates of delayed graft function (N0, 19.9%; N+, 12.5%), acute rejections (N0, 25.5%; N0, 33.3%), chronic allograft dysfunction (N0, 15.8%; N+, 28.6%). Graft function at 1 month as well as 1 and 5 years were comparable. Patient and graft survivals were similar at 1 and 5 years. There were no differences in the causes of graft loss or patient death.

Conclusion: In patients with ADPKD native nephrectomy of massively enlarged kidneys may be safely performed during the transplant procedure with no repercussions on the length of hospital stay, graft short- and long-term function and patient survival. However the procedure eads to a longer operative time and greater need for fluids and blood products.