There is no consensus on whether or when a native nephrectomy should be carried out in ADPKD patients undergoing kidney transplantation. In the PKD Expertise Center, nephrectomy is only performed in patients with significant symptoms, such as major volume-related complaints, lack of room for the allograft, recurrent cyst infections, persistent cyst bleedings, or chronic refractory discomfort. For a retrospective cohort analysis, researchers investigated whether this strategy is appropriate.
They looked at every patient with ADPKD who underwent kidney transplantation between January 2000 and January 2019. No nephrectomy (no-Nx), nephrectomy conducted before (pre-Tx), or nephrectomy performed after kidney transplantation were the three groups into which patients were separated (post-Tx). In the center, simultaneous nephrectomy and transplantation were not done.
There were 391 patients (males made up 55%, age 54±9 years). The majority of patients (n=257, 65.7%) did not have a nephrectomy. In 114 patients, a nephrectomy was done prior to treatment (29.2%). Only 30 patients had nephrectomy after treatment (7.7%, median 4.4 years post-Tx). There were no differences in the rates of surgical complications between the 2 groups (38.3% pre-Tx vs. 27.0% post-Tx, P=0.2), or in the 10-year survival rates for patients (74.4% pre-Tx vs. 80.7% post-Tx vs. 67.6% no-Nx, P=0.4), or in the 10-year survival rates for grafts (84.4% pre-Tx vs. 85.5% post-Tx vs. 90.0% no-Nx, P=0.9)
According to the study, only a portion of ADPKD patients required a native nephrectomy when kidney transplantation was considered a treatment option.