Simultaneous ipsilateral nephrectomy during kidney transplantation in autosomal dominant polycystic kidney disease: a ma
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ORIGINAL ARTICLE
Simultaneous ipsilateral nephrectomy during kidney transplantation in autosomal dominant polycystic kidney disease: a matched pair analysis of 193 consecutive cases Bernd Martin Jänigen 1 & Johann Hempel 1 & Philipp Holzner 1 & Johanna Schneider 2 & Stefan Fichtner-Feigl 1 & Oliver Thomusch 1 & Hannes Neeff 1 & Przemyslaw Pisarski 1 & Torben Glatz 1,3 Received: 31 March 2020 / Accepted: 19 July 2020 # The Author(s) 2020
Abstract Background In end-stage renal transplant recipients with autosomal-dominant polycystic kidney disease (ADPKD), the imperative, optimal timing, and technique of native nephrectomy remains under discussion. The Freiburg Transplant Center routinely performs a simultaneous ipsilateral nephrectomy. Methods From April 1998 to May 2017, we retrospectively analyzed 193 consecutive ADPKD recipients, receiving per protocol simultaneous ipsilateral nephrectomy and compared morbidity, mortality, and outcome with 193 non-ADPKD recipients of a matched pair control. Results The incidence of surgical complications was similar with respect to severe medical, surgical, urological, vascular, and wound-related complications as well as reoperation rates and 30-day mortality. Intraoperative blood transfusions were required more often in the ADPKD (22.8%) compared with the control group (6.7%; p < 0.0001). Early postoperative urinary tract infections occurred more frequent (ADPKD 40.4%/control 29.0%; p = 0.0246). Time of surgery was prolonged by 30 min (ADPKD 169 min; 95%CI 159.8–175.6 min/control 139 min; 95%CI 131.4–145.0 min; p < 0.0001). One-year patient (ADPKD 96.4%/control 95.8%; p = 0.6537) and death-censored graft survival (ADPKD 94.8%/control 93.7%; p = 0.5479) were comparable between both groups. Conclusions With respect to morbidity and mortality, per protocol, simultaneous native nephrectomy is a safe procedure. Especially in asymptomatic ADPKD KTx recipients, the number of total operations can be reduced and residual diuresis preserved up until transplantation. In living donation, even preemptive transplantation is possible. Keywords Simultaneous unilateral nephrectomy . Renal transplantation . Polycystic kidney disease . ADPKD
Introduction The risk of end-stage renal disease (ESRD) in ADPKD patients is age-related. By the age of 60 years, about 50% of
* Bernd Martin Jänigen [email protected] 1
Faculty of Medicine, Department of General and Digestive Surgery, Section of Transplant Surgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
2
Faculty of Medicine Department of Medicine IV, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
3
Department of Surgery, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
patients require dialysis [1]. This group represents about 10– 15% of patients on dialysis [2] and approximately 10% of all renal transplant recipients [3, 4]. Other treatment options, targeting the underlying pathophysiological mechanisms in order to preserve kidney function are currently being eva
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