Work

Bilateral nephrectomy in autosomal dominant polycystic kidney disease patients before or after renal transplantation: data from a retrospective cohort study

Year: 2025

Type: article

Abstract: ABSTRACT Background The indication and timing of native nephrectomy in autosomal dominant polycystic kidney disease (ADPKD) kidney transplant recipients are a matter of ongoing debate. Data on bilateral nephrectomy in such patients is scarce. This study therefore compares the clinical outcome of ADPKD patients undergoing bilateral nephrectomy before or after transplantation. Methods This retrospective single-center study analyzed all ADPKD patients undergoing kidney transplantation at our department between January 2007 and December 2017. Surgical complications, according to the Clavien-Dindo classification, and long-term graft outcomes were compared between ADPKD kidney transplant recipients undergoing bilateral nephrectomy pre- vs posttransplant. Results A total of 273 kidney transplants were performed in ADPKD patients. Of these, 107 (39.2%) patients required native nephrectomy. Unilateral and bilateral nephrectomy was performed in 36 (33.6%) and 71 (66.4%) patients, respectively. We compared seven patients with bilateral nephrectomy before vs 20 patients after kidney transplantation. Pain and cyst infections were the most common indications in both groups. Operation time (P = .001) and perioperative transfusion requirements (P < .001) were significantly increased in the pretransplant nephrectomy group. The total number of Clavien-Dindo complications grade III (P = .054) and IV (P = .015) was greater in patients with nephrectomy preceding transplantation. However, 1-, 3- and 5-year graft and patient survival (P = .347 and P = .596) were not different between the pre- and posttransplant nephrectomy approaches. Conclusions A posttransplant nephrectomy appears to be a relatively safe procedure. However, bilateral nephrectomies are highly invasive and should be avoided unless absolutely necessary. The timing and surgical outcome after nephrectomy do not significantly affect long-term graft or patient survival.

Source: Clinical Kidney Journal

DOI: 10.1093/ckj/sfaf155