Sequential vs. Simultaneous Bilateral Native Nephrectomy and Renal Transplantation for Autosomal Dominant Polycystic Kidney Disease

Hong, Jisun; Kim, Sung Joo; Lee, Suk Koo; Joh, Jae Won; Kwon, Choon Hyuck David; Choi, Gyu Seong; Park, Jae Berm

Abstract

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common inherited kidney diseases and a frequent cause of end-stage renal failure. Generally accepted indications of nephrectomy in ADPKD cases are recurrent pyelonephritis, cyst hemorrhage, pain refractory to medical management and massively enlarged kidneys. Although pretransplant nephrectomy has been applied in these patients, evidence of the benefits of this strategy is lacking.
METHODS
ADPKD patients transplanted from cadaveric or living donors were reviewed retrospectively regard to posttransplant complications and outcomes. We compared operative time, hospital day, serum creatinine at discharge and at 1year after transplantation, complication, rejection and graft loss.
RESULTS
Between February 1995 and March 2008, 24 patients with end stage ADPKD received kidney transplantation at our hospital. 14 patients underwent simultaneous bilateral nephrectomy (Group I), 10 patients underwent pretransplant sequential nephrectomy (Group II). The mean operative time was 5.87+/-1.17, 9.52+/-2.67 hours in Group I and II, respectively (P=0.001). The mean hospital stay was different between Group I and II at 20.8+/-6.0, 42.8+/-17.6 days, respectively (P<0.001). Overall posttransplant complications were more frequent in the sequential nephrectomy (43% vs 80%); however, the difference was not statistically significant. Also about rejection, graft loss, there are no statistically significant differences.
CONCLUSIONS
Our data imply that there is no higher morbidity or mortality when performing simultaneous bilateral nephrectomy during renal transplantation in patients with renal failure due to ADPKD. Therefore if bilateral nephrectomy is performed as an adjunct to transplantation, it is tolerable to be done at the same time as renal grafting.