Kidney transplantation with and without simultaneous bilateral native nephrectomy in patients with polycystic kidney disease: a comparative retrospective study.
ABSTRACT Patients with autosomal dominant polycystic kidney disease (ADPKD) often need to undergo native nephrectomy and are candidates for kidney transplantation. The necessity and timing of nephrectomy are controversial. Some authors recommend simultaneous bilateral native nephrectomy (SBN) as the preferred option in living-donor kidney transplantation (LDKT). These recommendations are based on small study populations. We therefore set out to study outcomes of LDKT with SBN, compared with LDKT alone in a larger single-center cohort.
A consecutive series of 159 patients with ADPKD undergoing LDKT were included in the study. Of the 159 patients, 2 were excluded because of missing data, 79 underwent LDKT alone (group A), and 78 underwent LDKT with SBN (group B). Demographic data and intraoperative and postoperative data were collected from patient charts and the national kidney registry.
There were no differences regarding background data. Group B experienced significantly longer operating times (183.7 vs. 319.3 min, P<0.001), a greater need for blood transfusions (0.1 vs. 1.6 units, P<0.001) and plasma products (35.1 vs. 438.3 mL, P<0.001), and longer hospital stays (11.8 vs. 15.4 days, P<0.001). It also experienced more intraoperative events and postoperative complications but fewer reoperations/reinterventions. There were no differences in patient and graft survival rates.
SBN in patients undergoing LDKT for ADPKD does not have a significant negative impact on patient and graft survival rates. It obviates a separate surgical procedure but requires longer hospital stay. It may be associated with more postoperative complications and risk of graft loss. These considerations should be communicated to the recipient and the donor.
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ABSTRACT: PURPOSE: Bilateral native nephrectomy (BNN) with simultaneous kidney transplantation (SKT) is becoming more common for patients with polycystic kidney disease (PKD) in the living donor nephrectomy era. Single center reports evaluating the short and long-term outcomes of SKT have been published but are generally limited by their small sample sizes. The purpose of this study was to examine population-level data to broadly define the complications of SKT. MATERIALS AND METHODS: The Nationwide Inpatient Sample (NIS) was used to acquire data on 2,368 patients with PKD undergoing bilateral native nephrectomies between 1998 to 2010. Unadjusted, multivariable- and propensity score-adjusted analysis of postoperative outcomes was performed. RESULTS: A total of 2,368 patients were included in this study. Of these, 271 patients (11.4%) underwent SKT. Patients who underwent SKT had higher rates of intraoperative hemorrhage (propensity score-adjusted odds ratio [PS-OR] 3.3, P=0.01), blood transfusions (PS-OR 4.2, P<0.0001) and urologic complications (PS-OR 5.5, P<0.0001) but lower rates of in-hospital mortality (15.8% vs. 1.1%; PS-OR 0.10, P<0.0001). Median length of hospitalization was also significantly higher in patients undergoing SKT (6 vs. 9 days, P<0.0001). Among the top quartile of high-volume hospitals, intraoperative hemorrhage, blood transfusion rates, and urologic complications remained statistically higher among patients undergoing SKT, but in-hospital mortality was similar on multivariable logistic regression (OR 0.2, P=0.17). CONCLUSIONS: With the exception of increased rates of intraoperative hemorrhage, blood transfusions, and urologic complications there are no significant differences in postoperative adverse outcomes in this large population-based study of patients undergoing SKT compared to BNN alone.The Journal of urology 05/2013; 190(6). DOI:10.1016/j.juro.2013.05.057 · 3.75 Impact Factor
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ABSTRACT: Background. Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disorder leading to end-stage renal failure. The objective of this study was to evaluate a longitudinal experience of kidney transplantation for ADPKD. Methods. A single center retrospective review of patients undergoing kidney transplantation was conducted, with comparisons across two time periods: early (02/2000-04/2007, n = 66) and late (04/2007-08/2012, n = 67). Results. Over the 13.5-year study period, 133 patients underwent transplantation for ADPKD. Overall, no significant difference between the early and late group with regard to intraoperative complications, need for reoperation, readmissions within 30 days, delayed graft function, and mortality was noted. There was a trend towards increase in one-year graft survival (early 93.1% versus late 100%, P = 0.05). In the early group, 67% of recipients had undergone aneurysm screening, compared to 91% of recipients in the late group (P < 0.001). Conclusions. This study demonstrates consistent clinical care with a trend towards improved rates of one-year graft survival. Interestingly, we also note a significantly higher use of cerebral imaging over time, with the majority that were detected requiring surgical intervention which may justify the current practice of nonselective radiological screening until improved screening criteria are developed.Journal of Transplantation 01/2014; 2014:675697. DOI:10.1155/2014/675697