Abstract | Keywords | Export | Availability | Bookmark

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Introduction ADPKD is the main genetic cause of inherited end-stage renal disease in the world. Nephrectomies are common procedures in these patients performed in roughly 20% of them. They can be executed before, after or at the same time as a kidney transplantation. Common indications are lack of space for a future kidney transplant, pain, recurrent cyst infections and bleeding. There is still a lot of debate on the need and the timing of a nephrectomy in these patients especially for those patients who are kidney transplant candidates. Objectives The aim of this study is to investigate the influence of kidney volumes on indications for a nephrectomy, and to compare the pre-, peri- and post-operative information in ADPKD patients who are kidney transplant candidates. This data is used to suggest an evidence based surgical policy and to evaluate our surgical approach for performing a nephrectomy in ADPKD patients. Methods A retrospective analysis of all ADPKD patients who are candidates for a kidney transplantation between 1-1-2008 and 31-12-2019 in the University hospital of Leuven was performed. The volume of the native kidneys was determined using the CT imaging program Syngo.via®. Post-operative complications were collected up to one year after kidney transplantation or nephrectomy. They were scored according to the Clavien-Dindo classification and the comprehensive complication index was calculated. All data was compared based on the timing of the patients procedures and on the indications of the nephrectomy. Results A total of 182 patients were included in this study who underwent 122 kidney transplantations and 66 nephrectomies. The majority of nephrectomies were performed prior to a renal transplantation. The most common indication for a nephrectomy were the lack of space for a future kidney transplantation. The volumes of the abdominal cavity and the kidneys were significantly higher in patients receiving a nephrectomy than those without the procedure. This difference was found for both the absolute and relative volumes. When stratified based on the indication, a significantly higher volume was found in those with lack of space as an indication. The same significant difference was found for anatomical landmarks between indication groups. We observed no negative effect on the kidney function due to the nephrectomy. The late term kidney function was also not influenced by the timing of the nephrectomy. 30% of patients experienced major complications after transplantation. No difference was found between the timing of the transplantation and the number and gravity of complications post-procedure. 25% of patients experienced major complications post-nephrectomy. No differences were found based on the timing of the nephrectomies. No association was found for minor and/or major complications post-transplantation or post-nephrectomy. Conclusion We identified a cut off for the execution of a nephrectomy based on the volumes of the kidneys. We also determined that a nephrectomy should be performed based on the severity of the patients symptoms and not on the timing of the kidney transplantation as is our current standard of practice. In our experience, a nephrectomy does not compromise the results of a kidney transplantation. It remains a complex procedure that requires perfect surgical and medical management.