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Renal Transplantation from a Deceased Donor with Polycystic Kidney Disease. Case Rep Transplant 2021; 2021:6711155. [PMID: 34447598 PMCID: PMC8383719 DOI: 10.1155/2021/6711155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/24/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022] Open
Abstract
Renal transplantation is the gold standard treatment for patients with end-stage renal disease (ESRD) as it demonstrates improved long-term survival compared to patients who remain on renal replacement therapy. The widening gap between the demand and supply of organs warrants the expansion of donor criteria for renal transplantation. Kidneys with multiple cysts are often rejected for transplantation. Here, we present our recent experience of a 72-year-old patient with ESRD due to a biopsy-proven diabetic nephropathy who received a deceased donor kidney with adult polycystic kidney disease (APKD). At 31-month posttransplant, he had a serum creatinine of 1.6 mg/dL. Deceased donors affected by APKD should be considered an acceptable option for successful renal transplantation in select recipients, as well as an alternative kidney source to increase the donor pool.
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Qian X, Sheng X, Li R, Liu H, Kong X, Duan L, Qi J. Which Stage of ADPKD Is More Appropriate for Decortication? A Retrospective Study of 137 Patients from a Single Clinic. PLoS One 2015; 10:e0120696. [PMID: 25939015 PMCID: PMC4418663 DOI: 10.1371/journal.pone.0120696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/24/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To study retrospectively the efficacy of decortication in patients with different stages of ADPKD and to determine which stage for decortication is more appropriate. MATERIALS AND METHODS We analyzed 137 patients with ADPKD from 2001 to 2010. All patients were divided into three stages. A total of 70 patients underwent decortication, and we studied intraoperative indicators and postoperative indicators at 1 and 3 years follow-up. RESULTS In 70 patients who underwent decortication, significant differences were observed in operative duration and bleeding volume between patients with stage I and II ADPKD (P<0.05), but no significant differences were observed in intestinal recovery time, pain medication dose, and the days of postoperative hospitalization (P > 0.05). The total complication occurrence rate was significantly different between them (P < 0.05). The serum creatinine (Scr) levels in patients with stage I ADPKD were within normal limits 1 and 3 years postoperatively and did not differ significantly (P > 0.05). Scr levels were significantly decreased in patients with stage II ADPKD in the 1st postoperative year (P < 0.05), but these were not significant differences in the 3rd postoperative year (P > 0.05). In the 1st postoperative year, VAS value, blood pressure and renal volume significantly differed (P < 0.05). However, no significant differences were observed 3 years later (P > 0.05). CONCLUSIONS Decortication in patients with stage I ADPKD can alleviate back pain symptoms and decrease blood pressure within 1 year, but the long-term efficacy is not ideal. Scr levels can be maintained within normal limits, suggesting that decortication does not lead to deterioration of renal function. For patients with stage II ADPKD, decortication can significantly improve renal function over the short term. However, after 3 years, renal function returns to the preoperative level, and surgical difficulties and complications also increase.
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Affiliation(s)
- Xiaoqiang Qian
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xujun Sheng
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ruipeng Li
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hailong Liu
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiangjie Kong
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liujian Duan
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun Qi
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- * E-mail:
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Bahadur MM, Binnani P, Gupta R, Pattewar S. Marginal donor kidney in a marginal recipient: Five year follow-up. Indian J Nephrol 2011; 20:100-2. [PMID: 20835327 PMCID: PMC2931124 DOI: 10.4103/0971-4065.65306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The widening gap between demand and supply of organs became apparent as organ shortage became more severe. Organs previously considered unsuitable for transplantation are currently being used. Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary disease characterized by slow progressive cystic changes and deterioration of renal function. We provide our experience with an ADPKD patient who received a kidney from 38-year-old deceased donor ADPKD-affected kidney for renal transplantation.
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Affiliation(s)
- M M Bahadur
- Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India
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Canaud G, Knebelmann B, Harris PC, Vrtovsnik F, Correas JM, Pallet N, Heyer CM, Letavernier E, Bienaimé F, Thervet E, Martinez F, Terzi F, Legendre C. Therapeutic mTOR inhibition in autosomal dominant polycystic kidney disease: What is the appropriate serum level? Am J Transplant 2010; 10:1701-6. [PMID: 20642692 PMCID: PMC3697013 DOI: 10.1111/j.1600-6143.2010.03152.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease, and sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, has been shown to significantly retard cyst expansion in animal models. The optimal therapeutic dose of sirolimus is not yet defined. Here, we report the history of a previously unknown ADPKD deceased donor whose kidneys were engrafted in two different recipients. One of the two received an immunosuppressive regimen based on sirolimus for 5 years while the other did not. After transplantation, both patients developed severe transplant cystic disease. Donor DNA sequence identified a new hypomorphic mutation in PKD1. The rate of cyst growth was identical in the two patients regardless of the treatment. While sirolimus treatment reduced the activation of mTOR in peripheral blood mononuclear cells, it failed to prevent mTOR activation in kidney tubular cells, this could account for the inefficiency of treatment on cyst growth. Together, our results suggest that the dose of sirolimus required to inhibit mTOR varies according to the tissue.
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Affiliation(s)
- G. Canaud
- INSERM U845, Centre de Recherche Croissance et Signalisation, Hôpital Necker Rue de Sèvres, Paris,Service de Transplantation et Unité de Soins Intensifs, Hôpital Necker, APHP, Rue de Sèvres, Paris,Université Paris Descartes, Rue de l'Ecole de Médecine, Paris,Corresponding author: Guillaume Canaud,
| | - B. Knebelmann
- INSERM U845, Centre de Recherche Croissance et Signalisation, Hôpital Necker Rue de Sèvres, Paris,Université Paris Descartes, Rue de l'Ecole de Médecine, Paris,Service de Néphrologie Adultes, Hôpital Necker, APHP, Rue de Sèvres, Paris
| | - P. C. Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, MN
| | - F. Vrtovsnik
- Service de Néphrologie, Hôpital Bichat, APHP, Rue Henri-Huchard, Paris
| | - J. M. Correas
- Service de Radiologie Adultes, Hôpital Necker, APHP, Rue de Sèvres, Paris
| | - N. Pallet
- Service de Transplantation et Unité de Soins Intensifs, Hôpital Necker, APHP, Rue de Sèvres, Paris,Université Paris Descartes, Rue de l'Ecole de Médecine, Paris
| | - C. M. Heyer
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, MN
| | - E. Letavernier
- Service de Néphrologie, Hôpital Bichat, APHP, Rue Henri-Huchard, Paris
| | - F. Bienaimé
- INSERM U845, Centre de Recherche Croissance et Signalisation, Hôpital Necker Rue de Sèvres, Paris,Université Paris Descartes, Rue de l'Ecole de Médecine, Paris
| | - E. Thervet
- Service de Transplantation et Unité de Soins Intensifs, Hôpital Necker, APHP, Rue de Sèvres, Paris,Université Paris Descartes, Rue de l'Ecole de Médecine, Paris
| | - F. Martinez
- Service de Transplantation et Unité de Soins Intensifs, Hôpital Necker, APHP, Rue de Sèvres, Paris,Université Paris Descartes, Rue de l'Ecole de Médecine, Paris
| | - F. Terzi
- INSERM U845, Centre de Recherche Croissance et Signalisation, Hôpital Necker Rue de Sèvres, Paris,Université Paris Descartes, Rue de l'Ecole de Médecine, Paris
| | - C. Legendre
- Service de Transplantation et Unité de Soins Intensifs, Hôpital Necker, APHP, Rue de Sèvres, Paris,Université Paris Descartes, Rue de l'Ecole de Médecine, Paris
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Olsburgh JD, Godbole HC, O'Donnell PJ, Koffman GC, Taylor JD, Khan MS. Transplantation of kidneys from deceased adult polycystic donors. Am J Transplant 2006; 6:2809-11. [PMID: 17049067 DOI: 10.1111/j.1600-6143.2006.01539.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Renal transplantation is the best treatment for end-stage renal disease. The discrepancy between donor organ supply and demand continues to widen. Maximum efforts should be made to make use of donor kidneys and we suggest that polycystic kidneys can be suitable marginal donor organs. Five polycystic cadaveric donor kidneys were transplanted in four recipients at our institution between year 2000 and 2004. The donor kidneys were either of normal size or moderately enlarged (less than 15 x 10 cm). Donor ages were 24, 46 and 55 years. All donors had normal serum creatinine at the time of organ retrieval. Recipients gave informed consent to be transplanted with the polycystic kidneys. Three of four recipients had primary graft function. The patient with primary nonfunction required graft nephrectomy 8 weeks post-transplantation. One patient died due to cardiovascular causes with a functioning graft 18 months after transplantation. Two patients remain well, 26 and 58 months after transplantation, with normal graft function. Our experience and the limited evidence from the literature suggest that, with careful selection of both donor and recipient, transplantation of cadaveric polycystic donor kidneys should be considered given the current organ shortage.
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Affiliation(s)
- J D Olsburgh
- Department of Urology, Guy's & St. Thomas' NHS Foundation Trust & GKT School of Medicine, London SE1 9RT, UK
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