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Shaheen MF, Aljehaiman F, Altheaby A. Semi-simultaneous hand-assisted laparoscopic (HAL) bilateral nephrectomy and kidney transplantation from the same incision in ADPKD, first case report in Saudi Arabia. J Surg Case Rep 2024; 2024:rjae274. [PMID: 38706492 PMCID: PMC11066794 DOI: 10.1093/jscr/rjae274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/10/2024] [Indexed: 05/07/2024] Open
Abstract
This case report discusses the management of a 46-year-old male patient with autosomal dominant polycystic kidney disease and a high body mass index, who underwent a semi-simultaneous procedure involving hand-assisted laparoscopic bilateral nephrectomy to alleviate severe abdominal symptoms and prepare for a kidney transplantation, all using the same incision. This is the first reported occurrence of such a procedure in Saudi Arabia. Post-operatively, the patient made a successful recovery with excellent kidney function and no complications.
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Affiliation(s)
- Mohammed F Shaheen
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Hepatobiliary Sciences Department and Organ Transplant Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fahad Aljehaiman
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulrahman Altheaby
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Hepatobiliary Sciences Department and Organ Transplant Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Copur S, Ozbek L, Guldan M, Topcu AU, Kanbay M. Native nephrectomy in polycystic kidney disease patients on transplant lists: how and when? J Nephrol 2024:10.1007/s40620-024-01899-7. [PMID: 38512371 DOI: 10.1007/s40620-024-01899-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/10/2024] [Indexed: 03/23/2024]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD), the most common hereditary kidney disease, accounts for approximately 10% of the patients on kidney transplantation waitlists. High rates of complications including hemorrhage, infections, nephrolithiasis and kidney size-related compressive complaints have been reported among ADPKD patients. Therefore, the need for routine native nephrectomy and timing of such procedure in ADPKD patients being prepared for transplantation are debated. Even though pre-transplant nephrectomy has the potential to provide fewer infectious complications due to lack of immunosuppressive medication use, such procedure has been associated with longer hospital stay, loss of residual kidney function and need for dialysis. Although simultaneous nephrectomy and transplantation could potentially lead to longer perioperative duration, perioperative complications and need for blood transfusions, this was not confirmed in cohort studies. Therefore, some institutions routinely perform simultaneous unilateral nephrectomy and kidney transplantation. In this narrative review, our aim is to evaluate the current evidence regarding the need and timing of nephrectomy in ADPKD patients in relation to kidney transplantation.
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Affiliation(s)
- Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Lasin Ozbek
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Mustafa Guldan
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmet Umur Topcu
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, 34010, Istanbul, Turkey.
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The impact of pre-transplantation nephrectomy on quality of life in patients with autosomal dominant polycystic kidney disease. World J Urol 2023; 41:1193-1203. [PMID: 36930253 PMCID: PMC10160200 DOI: 10.1007/s00345-023-04349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/25/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE In selected ADPKD patients, a nephrectomy is required in the work-up for a kidney transplantation. Because the impact of this procedure is unknown, we investigated the effect of pre-transplantation nephrectomy on quality of life in this group. METHODS In this retrospective cohort study all ADPKD patients, ≥ 18 years, who received a kidney transplantation in 2 ADPKD expertise centers between January 2000 and January 2016, were asked to participate. Quality of life was assessed using three validated questionnaires on three time points. Nephrectomy was performed in preparation for transplantation. RESULTS Two hundred seventy-six ADPKD patients (53 ± 9 years, 56.2% male) were included. 98 patients (35.5%) underwent native nephrectomy in preparation for transplantation, of which 43 underwent bilateral nephrectomy. Pre-transplantation, ADPKD-IS scores were worse in the nephrectomy group vs. no-nephrectomy group (physical: 2.9 vs. 2.3, p < 0.001; emotional: 2.0 vs. 1.8, p = 0.03; fatigue: 3.0 vs. 2.3, p = 0.01). Post-transplantation and post-nephrectomy, ADPKD-IS scores improved significantly in both groups, with a significantly higher improvement in the nephrectomy group. During follow-up, all scores were still better compared to pre-transplantation. Observed physical QoL (ADPKD-IS physical 1.3 vs. 1.7, p = 0.04; SF-36 physical 50.0 vs. 41.3, p = 0.03) was better post-transplantation after bilateral nephrectomy compared to unilateral nephrectomy. In retrospect, 19.7% of patients would have liked to undergo a nephrectomy, while the decision not to perform nephrectomy was made by the treating physician. CONCLUSION This study shows that pre-transplantation nephrectomy improves quality of life in selected ADPKD patients. Bilateral nephrectomy may be preferred, although the risk of additional complications should be weighted.
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Prudhomme T, Boissier R, Hevia V, Campi R, Pecoraro A, Breda A, Territo A. Native nephrectomy and arterial embolization of native kidney in autosomal dominant polycystic kidney disease patients: indications, timing and postoperative outcomes. Minerva Urol Nephrol 2023; 75:17-30. [PMID: 36094388 DOI: 10.23736/s2724-6051.22.04972-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common causes of a need of renal replacement therapy. The need (elective vs. systematic) and timing of native kidney nephrectomy (before, after or during kidney transplantation) is a matter of debate and alternatives to surgery, mainly transcatheter arterial embolization have been explored. We performed a systematic review to report all available evidence on postintervention outcomes of native nephrectomy and arterial embolization in ADPKD patients. EVIDENCE ACQUISITION A search on Medline, Embase, and Cochrane databases was performed to identify all studies reporting outcomes of native nephrectomy or arterial embolization in APKDs. EVIDENCE SYNTHESIS Concerning native nephrectomy, a total of 3626 patients in 37 studies were included with 735, 210 and 2681 patients who underwent native nephrectomy respectively before, after or during kidney transplantation. Major complications were 12.2% in unilateral nephrectomy before transplantation, 25.0% in bilateral nephrectomy before transplantation, 17.7% in unilateral nephrectomy during transplantation, 20.8% in bilateral nephrectomy during transplantation and 23.8% in unilateral and bilateral nephrectomy after transplantation. A total of 230 patients in 7 series of arterial embolization were included. All arterial embolization were performed before transplantation. Mean volume reduction ranged from 36.3% at 3 months to 49% at 6 months. The major postintervention complication rate was 1%. CONCLUSIONS Unilateral native nephrectomy before kidney transplantation was associated with the lowest major postoperative complication rate and appears to be the preferred strategy. Arterial embolization reduces kidney volume by 49% at 6 months. Arterial embolization could be considered when the reduction in size of the native kidney is not urgent.
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Affiliation(s)
- Thomas Prudhomme
- Department of Urology, Rangueil University Hospital, Toulouse, France -
| | - Romain Boissier
- Department of Urology, La Conception University Hospital, Marseille, France
| | - Vital Hevia
- Department of Urology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Riccardo Campi
- Department of Urology, University Hospital of Florence, Florence, Italy
| | - Alessio Pecoraro
- Department of Urology, University Hospital of Florence, Florence, Italy
| | - Alberto Breda
- Unit of Oncology and Renal Transplant, Puigvert's Foundation, Barcelona, Spain
| | - Angelo Territo
- Unit of Oncology and Renal Transplant, Puigvert's Foundation, Barcelona, Spain
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Simonov PA, Firsov MA, Arutunyan VS, Laletin DI, Alekseeva EA. Options for approaches to nephrectomy in patients with end-stage chronic kidney disease caused by autosomal dominant polycystic kidney disease: A review. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.10.201829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Autosomal-dominant polycystic kidney disease is a common kidney disease that affects all racial groups around the world, occupies one of the leading places in the structure of urological diseases and forms a significant contribution to the structure of all causes leading to the end stage of chronic renal failure, disabling patients in this group and hence leading to the inevitability of renal replacement therapy. A highly effective clinical method for replacing lost kidney function is kidney transplantation. Based on the fact that the number of patients with this pathology is increasing, it is necessary to search for and introduce clear criteria for the best care, taking into account the high likelihood of developing infectious complications, hematuria, the absence or presence of diuresis, arterial hypertension in this category of patients. The article reflects the various methods of nephrectomy in patients suffering from autosomal dominant polycystic kidney disease, as well as how approaches to nephrectomy have evolved. The results of complications, as well as patient and graft survival in domestic and foreign studies, in which bilateral or ipsilateral nephrectomy was used using open or laparoscopic access before, during or after kidney transplantation, are demonstrated. Preference is rightfully given to minimally invasive methods of surgical treatment. Taking into account the already reduced resources of the organism of these patients, the volume and method of surgical treatment should be carefully chosen, taking into account safety, efficacy and risk minimization.
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Spaggiari M, Almario J, Aguiluz G, Furian L, Bartlett S, Cocco PD, Tzvetanov IG, Benedetti E, Giulianotti PC. Simultaneous Robotic-Assisted Bilateral Native Nephrectomy and Kidney Transplantation for Autosomal Dominant Polycystic Kidney Disease in Recipients With High Body Mass Index: Report of 2 Cases. Transplant Proc 2022; 54:1781-1785. [PMID: 35909011 DOI: 10.1016/j.transproceed.2022.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/31/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022]
Abstract
Robotic kidney transplantation is a safe, reproducible, and less morbid technique in high body mass index and end-stage renal disease. Polycystic kidney disease is a relative contraindication to robotic-assisted kidney transplantation because of the mass effect of the native kidneys on the patient's pelvis that prevents ideal exposure. We report the first 2 cases of robotic-assisted simultaneous bilateral nephrectomy and kidney transplantation for patients with obesity and adult polycystic kidney disease. The recipients were 2 males, 50 and 53 years old, with a body mass index of 35.1 41.6 kg/m2 and 41.6 kg/m2, respectively. Both recipients had suitable living donors. The average operating time was 395 minutes and the estimated blood loss was on average 250 mL. The postoperative course was uneventful and the patients were discharged home on days 4 and 5. Performing robotic nephrectomies simultaneously with kidney transplantation can be done safely, allowing patients with obesity and polycystic kidney disease needing bilateral nephrectomy, to take full advantage of minimally invasive kidney transplantation.
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Affiliation(s)
- Mario Spaggiari
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois.
| | - Jorge Almario
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Gabriela Aguiluz
- Division of General, Minimally Invasive, & Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Stephen Bartlett
- Department of Surgery, OSF Saint Anthony Medical Center, Rockford, Illinois
| | - Pierpaolo Di Cocco
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Ivo G Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Pier C Giulianotti
- Division of General, Minimally Invasive, & Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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Darius T, Bertoni S, De Meyer M, Buemi A, Devresse A, Kanaan N, Goffin E, Mourad M. Simultaneous nephrectomy during kidney transplantation for polycystic kidney disease does not detrimentally impact comorbidity and graft survival. World J Transplant 2022; 12:100-111. [PMID: 35663541 PMCID: PMC9136716 DOI: 10.5500/wjt.v12.i5.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/11/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The lack of space, as an indication for a native unilateral nephrectomy for positioning a future kidney graft in the absence of other autosomal dominant polycystic kidney disease-related symptoms, remains controversial.
AIM To evaluate the surgical comorbidity and the impact on graft survival of an associated ipsilateral native nephrectomy during isolated kidney transplantation in patients with autosomal dominant polycystic kidney disease.
METHODS One hundred and fifty-four kidney transplantations performed between January 2007 and January 2019 of which 77 without (kidney transplant alone (KTA) group) and 77 with associated ipsilateral nephrectomy (KTIN group), were retrospectively reviewed. Demographics and surgical variables were analyzed and their respective impact on surgical comorbidity and graft survival.
RESULTS Creation of space for future graft positioning was the main reason (n = 74, 96.1%) for associated ipsilateral nephrectomy. No significant difference in surgical comorbidity (lymphocele, wound infection, incisional hernia, wound hematoma, urinary infection, need for blood transfusion, hospitalization stay, Dindo Clavien classification and readmission rate) was observed between the two study groups. The incidence of primary nonfunction and delayed graft function was comparable in both groups [0% and 2.6% (P = 0.497) and 9.1% and 16.9% (P = 0.230), respectively, in the KTA and KTIN group]. The 1- and 5-year graft survival were 94.8% and 90.3%, and 100% and 93.8%, respectively, in the KTA and KTIN group (P = 0.774). The 1- and 5-year patient survival were 96.1% and 92.9%, and 100% and 100%, respectively, in the KTA and KTIN group (P = 0.168).
CONCLUSION Simultaneous ipsilateral native nephrectomy to create space for graft positioning during kidney transplantation in patients with autosomal dominant polycystic kidney disease does not negatively impact surgical comorbidity and short- and long-term graft survival.
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Affiliation(s)
- Tom Darius
- Surgical and Abdominal Transplantation Unit, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Sébastien Bertoni
- Surgical and Abdominal Transplantation Unit, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Martine De Meyer
- Surgical and Abdominal Transplantation Unit, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Antoine Buemi
- Surgical and Abdominal Transplantation Unit, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Arnaud Devresse
- Division of Nephrology, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Nada Kanaan
- Division of Nephrology, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Eric Goffin
- Division of Nephrology, University Clinics Saint Luc, Brussels 1200, Belgium
| | - Michel Mourad
- Surgical and Abdominal Transplantation Unit, University Clinics Saint Luc, Brussels 1200, Belgium
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Abbas M, Pätzel M, Thurn A, Brinkmann OA, Bettendorf O. Incidental occurrence of papillary renal cell carcinoma in the native kidney with autosomal dominant polycystic kidney disease after renal transplantation: A case report. Mol Clin Oncol 2021; 15:223. [PMID: 34548922 PMCID: PMC8447179 DOI: 10.3892/mco.2021.2386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/13/2021] [Indexed: 11/05/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is one of the best-known genetic diseases. Almost half of the patients with ADPKD will develop end-stage renal disease, and the majority of patients are treated with renal transplantation. The current study presents a case that developed papillary renal cell carcinoma (PRCC) in the native right kidney 10 years after renal transplantation. PRCC is a not common malignant tumour entity (18.5% of all cases of renal cell carcinoma) compared with common clear cell renal carcinoma (65-70% of all cases of RCC).
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Affiliation(s)
- Mahmoud Abbas
- Institute of Pathology and Cytology, D-48465 Schüttorf, Germany
| | - Melanie Pätzel
- Urology Department, Bonifatius Hospital, D-49808 Lingen, Germany
| | - Angelika Thurn
- Institute of Pathology and Cytology, D-48465 Schüttorf, Germany
| | | | - Olaf Bettendorf
- Institute of Pathology and Cytology, D-48465 Schüttorf, Germany
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Xu J, D'Souza K, Lau NS, Leslie S, Lee T, Yao J, Lam S, Sandroussi C, Chadban S, Ying T, Pleass H, Laurence JM. Staged versus concurrent native nephrectomy and renal transplantation in patients with autosomal dominant polycystic kidney disease: A systematic review. Transplant Rev (Orlando) 2021; 36:100652. [PMID: 34688508 DOI: 10.1016/j.trre.2021.100652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) frequently undergo native nephrectomy before transplantation. The nephrectomy may be a staged procedure or undertaken simultaneously with transplantation. When performed simultaneously, the transplant procedure is more prolonged, involves a larger operative field and incision. There is also a concern of a greater risk of graft loss with simultaneous nephrectomy and transplantation. Moreover, staged surgery may allow nephrectomy to be performed before immunosuppression introduction via a smaller incision or involving a minimally invasive approach. However, staged nephrectomy may require a period of dialysis not otherwise necessary if a transplant and nephrectomy were simultaneous. Moreover, only a single procedure is needed, implying the avoidance of a prior nephrectomy and its attendant morbidity in a patient with chronic renal insufficiency. To account for these issues, this study aims to compare the cumulative morbidity of two-staged procedures versus a single simultaneous approach in term of morbidity and graft outcomes. OBJECTIVES This study aims to systematically review the literature to determine whether a staged or simultaneous approach to native nephrectomy in ADPKD is the optimal approach in terms of morbidity and graft outcomes. METHODS A literature search of MEDLINE and EMBASE was conducted to identify published systematic reviews, randomized control trials, case-controlled studies and case studies. Data comparing outcomes of staged and simultaneous nephrectomy for patients undergoing kidney transplantation was extracted and analyzed. The main outcomes analyzed were length of hospitalization, blood loss, operative time, other early postoperative complications and risk of graft thrombosis. Meta-analysis was conducted where appropriate. RESULTS Seven retrospective cohort studies were included in the review. There was a total of 385 patients included in the analysis, of whom 273 patients underwent simultaneous native nephrectomy and kidney transplantation. Meta-analysis showed an increased cumulative operative time in staged procedures (RR 1.86;95% CI 0.43-3.29 p = 0.01) and increased risk of blood transfusions (RR 2.69; 95% CI 1.92-3.46 p < 0.00001). For the transplant procedure, there were no significant difference in the length of stay (RR 1.03; 95% CI -2.01-4.14 p = 0.52), major postoperative complications (RR 0.02; 95% CI -0.15-0.10 p = 0.74) and vascular thromboses (RR 1.42 95% CI 0.23-8.59 p = 0.7). CONCLUSION The results suggest that staged nephrectomy followed by kidney transplantation is associated with a longer cumulative operative time and increased cumulative risk of blood transfusions. There is no evidence to suggest that performing a simultaneous nephrectomy and kidney transplant procedure increases the perioperative mortality rate, major postoperative complication rates or risk of vascular thrombosis.
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Affiliation(s)
- Josephine Xu
- RPA Institute of Academic Surgery, University of Sydney, Australia; Department of Transplant Surgery, Royal Prince Alfred Hospital, University of Sydney, Australia
| | | | - Ngee Soon Lau
- RPA Institute of Academic Surgery, University of Sydney, Australia; Department of Transplant Surgery, Royal Prince Alfred Hospital, University of Sydney, Australia
| | - Scott Leslie
- RPA Institute of Academic Surgery, University of Sydney, Australia; University of Sydney Medical School, Australia; Department of Urology, Royal Prince Alfred Hospital, University of Sydney, Australia
| | - Taina Lee
- Department of Surgery, Westmead Hospital, University of Sydney, Australia
| | - Jinna Yao
- Department of Surgery, Westmead Hospital, University of Sydney, Australia
| | - Susanna Lam
- RPA Institute of Academic Surgery, University of Sydney, Australia
| | - Charbel Sandroussi
- RPA Institute of Academic Surgery, University of Sydney, Australia; Department of Transplant Surgery, Royal Prince Alfred Hospital, University of Sydney, Australia
| | - Steven Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, University of Sydney, Australia; University of Sydney Medical School, Australia
| | - Tracey Ying
- Department of Renal Medicine, Royal Prince Alfred Hospital, University of Sydney, Australia; University of Sydney Medical School, Australia
| | - Henry Pleass
- Department of Surgery, Westmead Hospital, University of Sydney, Australia; Department of Renal Medicine, Royal Prince Alfred Hospital, University of Sydney, Australia
| | - Jerome Martin Laurence
- RPA Institute of Academic Surgery, University of Sydney, Australia; Department of Surgery, Westmead Hospital, University of Sydney, Australia; Department of Transplant Surgery, Royal Prince Alfred Hospital, University of Sydney, Australia; University of Sydney Medical School, Australia.
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10
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Timing of Nephrectomy and Renal Transplantation in Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) in the Era of Living Kidney Donation. TRANSPLANTOLOGY 2020. [DOI: 10.3390/transplantology1010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary disorders. Once progressed to end-stage renal disease, kidney transplantation may be needed. Whether and when to perform a (bilateral) native nephrectomy in case of end-stage renal failure are issues under debate. At our institution, with a growing number of living kidney donations, the general trend is to perform a native nephrectomy prior to transplantation. Our aim was to compare the outcomes of this approach to a nephrectomy during or after transplantation and to compare our findings to results reported in the literature. Data were prospectively collected from all ADPKD patients undergoing native nephrectomy and kidney transplantation at the Leiden University Medical Center between 2000–2017. A literature search was performed in the PubMed and Scopus databases. The clinical results were retrospectively reviewed and were stratified according to the timing of the nephrectomy. From the literature review, the most practiced approach was a combined unilateral nephrectomy and kidney transplantation. However, in our series, the favored approach was to perform a scheduled bilateral nephrectomy prior to kidney transplantation. A total of 114 patients underwent a native nephrectomy prior to (group 1, n = 85), during (group 2, n = 5), or after (group 3, n = 24) kidney transplantation. There were no statistically significant differences in postoperative morbidity after nephrectomy nor differences in kidney transplant outcome. Bilateral nephrectomy prior to kidney transplantation is a safe, controlled approach carrying minimal complication and mortality rates and facilitating a subsequent transplant procedure without mechanical or hemodynamic limitations for the graft.
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Jänigen BM, Hempel J, Holzner P, Schneider J, Fichtner-Feigl S, Thomusch O, Neeff H, Pisarski P, Glatz T. Simultaneous ipsilateral nephrectomy during kidney transplantation in autosomal dominant polycystic kidney disease: a matched pair analysis of 193 consecutive cases. Langenbecks Arch Surg 2020; 405:833-842. [PMID: 32705344 PMCID: PMC7471159 DOI: 10.1007/s00423-020-01939-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022]
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.
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Affiliation(s)
- Bernd Martin Jänigen
- Faculty of Medicine, Department of General and Digestive Surgery, Section of Transplant Surgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.
| | - Johann Hempel
- Faculty of Medicine, Department of General and Digestive Surgery, Section of Transplant Surgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Philipp Holzner
- Faculty of Medicine, Department of General and Digestive Surgery, Section of Transplant Surgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Johanna Schneider
- Faculty of Medicine Department of Medicine IV, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Stefan Fichtner-Feigl
- Faculty of Medicine, Department of General and Digestive Surgery, Section of Transplant Surgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Oliver Thomusch
- Faculty of Medicine, Department of General and Digestive Surgery, Section of Transplant Surgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Hannes Neeff
- Faculty of Medicine, Department of General and Digestive Surgery, Section of Transplant Surgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Przemyslaw Pisarski
- Faculty of Medicine, Department of General and Digestive Surgery, Section of Transplant Surgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Torben Glatz
- Faculty of Medicine, Department of General and Digestive Surgery, Section of Transplant Surgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
- Department of Surgery, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
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Bellini MI, Charalmpidis S, Brookes P, Hill P, Dor FJMF, Papalois V. Bilateral Nephrectomy for Adult Polycystic Kidney Disease Does Not Affect the Graft Function of Transplant Patients and Does Not Result in Sensitisation. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7423158. [PMID: 31309115 PMCID: PMC6594324 DOI: 10.1155/2019/7423158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Native nephrectomy in Adult Polycystic Kidney Disease (ADPKD) patients is a major operation with controversy related to timing and indications. We present our single centre experience in transplanted patients and future candidates for transplantation. METHODS Retrospective analysis from an anonymised database of bilateral nephrectomies for ADPKD patients. Results were reported as median, range, and percentage. Differences between groups were tested using ANOVA and t-test. Surgery was performed between January 2012 and July 2018. RESULTS Thirty-three patients underwent bilateral native nephrectomy for APKD. 18 had a functioning kidney transplant (transplant group, 55%) while 15 patients were on dialysis (dialysis group, 45%) at the time of surgery; 8 patients of the latter group (24% of the whole cohort) were eventually transplanted. 53% were males, with median age of 55 years (27-71). Indications to surgery were the following: space (symptoms related to the size of the native kidneys or need to create space for transplantation) (59%), recurrent cyst infection (36%), haematuria (15%), pain (24%), and weight loss associated with cystic alteration on imaging (3%). In the transplant group, postoperative kidney function was not affected; haemoglobin serum levels significantly dropped in the whole cohort: 121 (82-150) g/L, versus 108 (58-154) g/L (p<0.001), with 14 patients being transfused perioperatively. Elevation of anti-HLA antibodies was noted in one female patient on dialysis, with no change in DSA levels and no rejection after transplant for all 26 transplanted patients. Median postoperative length of hospital stay was 9 days (6-71). One patient died (3%) after six months. Median follow-up for the whole cohort was 282 days (13-1834). Histopathological examination revealed incidental renal neoplasms in five cases (15%): 1 pT1a papillary renal cell carcinoma and 4 papillary adenomas. CONCLUSIONS Native nephrectomy for ADPKD could be safely performed in case of refractory symptoms, suspect of cancer or to create space for transplantation. It does not affect graft function or DSA status of transplanted patients or the prospect of transplantation of those on the waiting list.
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Affiliation(s)
- Maria Irene Bellini
- Renal and Transplant Directorate, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sotiris Charalmpidis
- Renal and Transplant Directorate, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Paul Brookes
- Department of Pathology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Peter Hill
- Renal and Transplant Directorate, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Frank J. M. F. Dor
- Renal and Transplant Directorate, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Vassilios Papalois
- Renal and Transplant Directorate, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College, London, UK
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Lozano-Vilardell P, Lara-Hernández R, Benabarre-Castany N, García-García D. Abdominal Aortic Aneurysm Associated with Polycystic Kidney Disease: Endovascular Aortic Repair and Renal Embolization. Ann Vasc Surg 2018; 56:351.e13-351.e15. [PMID: 30342219 DOI: 10.1016/j.avsg.2018.07.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/17/2018] [Indexed: 02/02/2023]
Abstract
A 79-year old patient with an asymptomatic 63-mm infrarenal abdominal aortic aneurysm, confirmed on computed tomography, was admitted in our unit. The patient had undergone kidney transplantation years before, due to renal failure secondary to polycystic kidney disease. Renal function at admission was normal. The aneurysm had a very short neck, and a standard endovascular aortic repair procedure was not feasible. Therefore, the 2 renal arteries were embolized with coils and endovascular repair of the aneurysm, covering the ostia of the renal arteries, was achieved placing the endoprosthesis up to the level of the superior mesenteric artery. The course of the patient was uneventful and was discharged without complications. Endovascular repair in patients without infrarenal aortic necks and nonfunctional kidneys secondary to polycystic kidney disease can be achieved with safety embolizing and covering the ostia of the renal arteries.
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Affiliation(s)
| | - Raúl Lara-Hernández
- Angiology and Vascular Surgery Department, Hospital Universitari Son Espases, Palma, Spain
| | - Noé Benabarre-Castany
- Angiology and Vascular Surgery Department, Hospital Universitari Son Espases, Palma, Spain
| | - David García-García
- Angiology and Vascular Surgery Department, Hospital Universitari Son Espases, Palma, Spain
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Jankowska M, Kuźmiuk-Glembin I, Skonieczny P, Dębska-Ślizień A. Native Nephrectomy in Renal Transplant Recipients With Autosomal Dominant Polycystic Kidney Disease. Transplant Proc 2018; 50:1863-1867. [DOI: 10.1016/j.transproceed.2018.02.100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/06/2018] [Indexed: 12/26/2022]
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Argyrou C, Moris D, Vernadakis S. Tailoring the 'Perfect Fit' for Renal Transplant Recipients with End-stage Polycystic Kidney Disease: Indications and Timing of Native Nephrectomy. ACTA ACUST UNITED AC 2018; 31:307-312. [PMID: 28438856 DOI: 10.21873/invivo.11060] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The ideal timing of native nephrectomy in relation to kidney transplantation in patients with autosomal-dominant polycystic kidney disease (ADPKD) can be a very puzzling decision for transplant surgeons and remains a matter of debate. This review article aims to present current literature regarding this highly controversial issue. MATERIALS AND METHODS The MEDLINE/PubMed database was searched using "polycystic kidney disease", "renal/kidney transplantation" and "native nephrectomy" as key words. Our search was focused on the optimal timing of and indications for native nephrectomy in renal transplant recipients with ADPKD. RESULTS In symptomatic cases, pre-transplant unilateral or bilateral native nephrectomy seems appropriate, in order to alleviate symptoms. In cases that are provided with the option of living-donor transplantation, the performance of the simultaneous procedure could be of benefit. When the principal indication of native nephrectomy is the creation of space for the renal allograft, various studies highlight the safety of the simultaneous approach of either unilateral or bilateral nephrectomy. CONCLUSION No consensus exists on the appropriate timing for native nephrectomy in patients with ADPKD. Several issues to be addressed in the decision-making process are the importance of residual diuresis, the longer operative time along with the associated prolonged ischemia time and higher complication rate of the combined procedure.
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Affiliation(s)
| | - Demetrios Moris
- Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, U.S.A.
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Live Donor Renal Transplant With Simultaneous Bilateral Nephrectomy for Autosomal Dominant Polycystic Kidney Disease Is Feasible and Satisfactory at Long-term Follow-up. Transplantation 2016; 100:407-15. [PMID: 26262506 DOI: 10.1097/tp.0000000000000838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Timing of bilateral nephrectomy (BN) is controversial in patients with refractory symptoms of autosomal dominant polycystic kidney disease (APKD) in need of a renal transplant. METHODS Adults who underwent live donor renal transplant (LRT) + simultaneous BN (SBN) from August 2003 to 2013 at a single transplant center (n = 66) were retrospectively compared to a matched group of APKD patients who underwent LRT alone (n = 52). All patients received general health and polycystic kidney symptom surveys. RESULTS Simultaneous BN increased operative duration, estimated blood loss, transfusions, intravenous fluid, and hospital length of stay. Most common indications for BN were pain, loss of abdominal domain, and early satiety. There were more intraoperative complications for LRT + SBN (6 vs 0, P = 0.03; 2 vascular, 2 splenic, and 1 liver injury; 1 reexploration to adjust graft positioning). There were no differences in Clavien-Dindo grade I or II (39% vs 25%, P = 0.12) or grade III or IV (7.5% vs 5.7%, P = 1.0) complications during the hospital course. There were no surgery-related mortalities. There were no differences in readmission rates (68% vs 48%, P = 0.19) or readmissions requiring procedures (25% vs. 20%, P = 0.51) over 12 months. One hundred percent of LRT + SBN allografts functioned at longer than 1 year for those available for follow-up. Survey response rate was 40% for LRT-alone and 56% for LRT + SBN. One hundred percent of LRT + SBN survey responders were satisfied with their choice of having BN done simultaneously. CONCLUSIONS Excellent outcomes for graft survival, satisfaction, and morbidity suggest that the combined operative approach be preferred for patients with symptomatic APKD to avoid multiple procedures, dialysis, and costs of staged operations.
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Jo HA, Park HC, Kim H, Han M, Jeong JC, Oh KH, Yang J, Jeon HJ, Koo TY, Ha J, Kwak C, Hwang YH, Ahn C. Effect of Simultaneous Nephrectomy on Perioperative Blood Pressure and Graft Outcome in Renal Transplant Recipients with Autosomal Dominant Polycystic Kidney Disease. KOREAN JOURNAL OF TRANSPLANTATION 2016. [DOI: 10.4285/jkstn.2016.30.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hyung Ah Jo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hayne Cho Park
- Department of Internal Medicine, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Hyunsuk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Miyeun Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Cheol Jeong
- Department of Nephrology, Ajou University School of Medicine, Suwon, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jaeseok Yang
- Transplantation Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Jung Jeon
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Tai Yeon Koo
- Transplantation Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Hwan Hwang
- Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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18
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García-Rubio JH, Carrasco Valiente J, Campos Hernández JP, Ruiz García J, Márquez López J, Regueiro López JC, Cano Castiñeira R, Pendón Ruiz de Mier MV, Requena Tapia MJ. Graft Survival in Patients With Polycystic Kidney Disease With Nephrectomy of Native Kidney Pretransplant. Transplant Proc 2015; 47:2615-7. [PMID: 26680051 DOI: 10.1016/j.transproceed.2015.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Autosomal-dominant polycystic disease (ADPKD) represents 5%-10% of cases of end-stage renal failure. However, management of these patients in terms of whether or not to perform a transplant and optimal timing remains controversial. The objective of our analysis was to evaluate graft survival in patients with ADPKD in which we conduct pretransplant nephrectomy. METHODS This retrospective study including renal transplant patients secondary to ADPKD in our hospital between January 2000 and December 2012. Pretransplant native kidney nephrectomy was indicated in cases of need for space or repeated complications (cysts). We compared the initial function and graft survival between groups of transplanted based on whether nephrectomy had been performed or not. RESULTS Eighty-seven patients underwent a kidney transplant owing to ADPKD; 62% (n = 54) were male, with an average age of 55.22 years. Twenty-seven patients (30%) underwent nephrectomy native kidneys before transplantation. There were no serious postoperative complications. Patients who underwent nephrectomy (group 1) showed values of creatinine of 1.57 and 1.50 mg/dL at 3 and 6 months, respectively. In the no nephrectomy group, these values were 2.03 and 1.83 mg/dL, respectively. Graft survival after the first year was of 98% for group 1 and 95% for group 2. The 5-year implant survival was 95% and 80%, respectively. CONCLUSIONS Native kidney nephrectomy before transplantation in ADPKD is safe in an experienced center, both in terms of surgery-related morbidity and mortality and graft survival and function.
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Affiliation(s)
- J H García-Rubio
- Hospital Universitario Reina Sofía, Avenida Menendez Pidal s/n, Córdoba, Spain.
| | - J Carrasco Valiente
- Hospital Universitario Reina Sofía, Avenida Menendez Pidal s/n, Córdoba, Spain
| | | | - J Ruiz García
- Hospital Universitario Reina Sofía, Avenida Menendez Pidal s/n, Córdoba, Spain
| | - J Márquez López
- Hospital Universitario Reina Sofía, Avenida Menendez Pidal s/n, Córdoba, Spain
| | - J C Regueiro López
- Hospital Universitario Reina Sofía, Avenida Menendez Pidal s/n, Córdoba, Spain
| | - R Cano Castiñeira
- Hospital Universitario Reina Sofía, Avenida Menendez Pidal s/n, Córdoba, Spain
| | | | - M J Requena Tapia
- Hospital Universitario Reina Sofía, Avenida Menendez Pidal s/n, Córdoba, Spain
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EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.2014.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Akoh JA. Current management of autosomal dominant polycystic kidney disease. World J Nephrol 2015; 4:468-479. [PMID: 26380198 PMCID: PMC4561844 DOI: 10.5527/wjn.v4.i4.468] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/23/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD), the most frequent cause of genetic renal disease affecting approximately 4 to 7 million individuals worldwide and accounting for 7%-15% of patients on renal replacement therapy, is a systemic disorder mainly involving the kidney but cysts can also occur in other organs such as the liver, pancreas, arachnoid membrane and seminal vesicles. Though computed tomography and magnetic resonance imaging (MRI) were similar in evaluating 81% of cystic lesions of the kidney, MRI may depict septa, wall thickening or enhancement leading to upgrade in cyst classification that can affect management. A screening strategy for intracranial aneurysms would provide 1.0 additional year of life without neurological disability to a 20-year-old patient with ADPKD and reduce the financial impact on society of the disease. Current treatment strategies include reducing: cyclic adenosine monophosphate levels, cell proliferation and fluid secretion. Several randomised clinical trials (RCT) including mammalian target of rapamycin inhibitors, somatostatin analogues and a vasopressin V2 receptor antagonist have been performed to study the effect of diverse drugs on growth of renal and hepatic cysts, and on deterioration of renal function. Prophylactic native nephrectomy is indicated in patients with a history of cyst infection or recurrent haemorrhage or to those in whom space must be made to implant the graft. The absence of large RCT on various aspects of the disease and its treatment leaves considerable uncertainty and ambiguity in many aspects of ADPKD patient care as it relates to end stage renal disease (ESRD). The outlook of patients with ADPKD is improving and is in fact much better than that for patients in ESRD due to other causes. This review highlights the need for well-structured RCTs as a first step towards trying newer interventions so as to develop updated clinical management guidelines.
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Shumate AM, Bahler CD, Goggins WC, Sharfuddin AA, Sundaram CP. Native Nephrectomy with Renal Transplantation is Associated with a Decrease in Hypertension Medication Requirements for Autosomal Dominant Polycystic Kidney Disease. J Urol 2015; 195:141-6. [PMID: 26318985 DOI: 10.1016/j.juro.2015.07.114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE We assessed hypertensive control after native nephrectomy and renal transplantation in patients with autosomal dominant polycystic kidney disease. MATERIALS AND METHODS Blood pressure control was studied retrospectively in 118 patients with autosomal dominant polycystic kidney disease who underwent renal transplantation between 2003 and 2013. Overall 54 patients underwent transplantation alone (group 1) and 64 underwent transplantation with concurrent ipsilateral nephrectomy (group 2). Of these 64 patients 32 underwent ipsilateral nephrectomy only (group 2a) and 32 underwent eventual delayed contralateral native nephrectomy (group 2b). The number of antihypertensive drugs and defined daily dose of each antihypertensive was recorded at transplantation and up to 36-month followup. RESULTS Comparing preoperative to postoperative medications at 12, 24 and 36-month followup, transplantation with concurrent ipsilateral nephrectomy had a greater decrease in quantity (-1.2 vs -0.5 medications, p=0.008; -1.1 vs -0.3, p=0.007 and -1.2 vs -0.4, p=0.03, respectively) and defined daily dose of antihypertensive drug (-3.3 vs -1.0, p=0.0008; -2.9 vs -1.0, p=0.006 and -2.7 vs -0.6, p=0.007, respectively) than transplantation alone at each point. Native nephrectomy continued to be a predictor of hypertensive requirements on multivariable analysis (p <0.0001). The mean decrease in number of medications in group 2b from after ipsilateral nephrectomy to 12 months after contralateral nephrectomy was -0.6 (p=0.0005) and the mean decrease in defined daily dose was -0.6 (p=0.009). CONCLUSIONS In patients with autosomal dominant polycystic kidney disease undergoing renal transplantation, concurrent ipsilateral native nephrectomy is associated with a significant decrease in the quantity and defined daily dose of antihypertensive drugs needed for hypertension control. Delayed contralateral native nephrectomy is associated with improved control of blood pressure to an even greater degree.
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Affiliation(s)
- Ashley M Shumate
- Department of Urology, Indiana University, Indianapolis, Indiana
| | - Clinton D Bahler
- Department of Urology, Indiana University, Indianapolis, Indiana
| | | | - Asif A Sharfuddin
- Department of Medicine/Division of Nephrology, Indiana University, Indianapolis, Indiana
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Abraham GP, Siddaiah AT, Das K, Ramaswami K, George DP, Thampan OS. Laparoscopic nephrectomy for autosomal dominant polycystic kidneys in patients with end-stage renal disease on maintenance hemodialysis: 10-year single surgeon experience from an Indian center. J Minim Access Surg 2015. [PMID: 26195877 PMCID: PMC4499924 DOI: 10.4103/0972-9941.140217] [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: 01/29/2023] Open
Abstract
CONTEXT Pure laparoscopic nephrectomy in patients with ADPKD (autosomal dominant polycystic kidney disease) and ESRD (end-stage renal disease) on MHD (maintenance hemodialysis) is challenging with high incidence of complications. Limited experiences from India has been reported in these scenarios. AIMS To present a 10-year single surgeon experience from India in laparoscopic nephrectomy in autosomal dominant polycystic kidneys (ADPKD) and end-stage renal disease (ESRD) on maintenance hemodialysis (MHD). SETTINGS AND DESIGN Retrospective. MATERIALS AND METHODS Retrospective analysis of records of similar subset of patients who were offered laparoscopic nephrectomy between 2003 and 2012. Preoperative, operative and postoperative parameters were recorded. Few technical modifications were adopted over the years. Patients were sub-classified into two groups (Group I: 2003-2006, Group II: 2007-2012) based on surgical technique. STATISTICAL ANALYSIS USED SAS software 9.1 version. RESULTS 75 patients (84 renal units, Group I: 31, Group II: 53) were included in this analysis. Unilateral procedure was performed in 66 and bilateral staged or simultaneous procedure in 9. Despite larger kidneys in Group II (mean longitudinal renal length 25.7 ± 3.4 vs 17.5 ± 2.7 centimeters, P <0.001), improved operative and postoperative profile were noted in Group II in several parameters-mean total operative time (205 ± 11.5 vs 310 ± 15.3 min, P = 0.00), time for specimen retrieval (30.5 ± 3.5 vs 45 ± 4.1 min, P = 0.02), postprocedure drop in hemoglobin (1.1 ± 0.1 vs 2.27 ± 0.03 grams/deciliter, P = 0.00). Conversion rates, intraoperative and postoperative events were also considerably less in Group II. CONCLUSIONS Despite existence of comorbidities and technical difficulties, laparoscopic nephrectomy in patients with ADPKD with ESRD and on MHD is a feasible option. Technical modifications with increasing surgeon's experience allows successful conductance of this approach in more complex cases with better outcome.
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Affiliation(s)
- George P Abraham
- Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India
| | - Avinash T Siddaiah
- Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India
| | - Krishanu Das
- Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India
| | | | - Datson P George
- Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India
| | - Oppukeril S Thampan
- Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India
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Wang Z, Vathsala A, Tiong HY. Haematuria in postrenal transplant patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:292034. [PMID: 25918706 PMCID: PMC4395992 DOI: 10.1155/2015/292034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 12/25/2022]
Abstract
Haematuria has a prevalence of 12% in the postrenal transplant patient population. It heralds potentially dangerous causes which could threaten graft loss. It is important to consider causes in light of the unique, urological, and immunological standpoints of these patients. We review the literature on common causes of haematuria in postrenal transplant patients and suggest the salient approach to the evaluation of this condition. A major cause of haematuria is urinary tract infections. There should be a higher index of suspicion for mycobacterial, fungal, and viral infection in this group of immunosuppressed patients. Measures recommended in the prevention of urinary tract infections include early removal of foreign bodies as well as prophylactic antibiotics during the early transplant phase. Another common cause of haematuria is that of malignancies, in particular, renal cell carcinomas. When surgically managing cancer in the setting of a renal transplant, one has to be mindful of the limited retropubic space and the need to protect the anastomoses. Other causes include graft rejections, recurrences of primary disease, and calculus formation. It is important to perform a comprehensive evaluation with the aid of an experienced multidisciplinary transplant team.
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Affiliation(s)
- Ziting Wang
- Department of Urology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Anantharaman Vathsala
- Division of Nephrology, Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
- National University Centre for Organ Transplantation, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Ho Yee Tiong
- Department of Urology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
- National University Centre for Organ Transplantation, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
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Bansal RK, Kapoor A. Laparoscopic nephrectomy for massive polycystic kidney disease: Updated technique and outcomes. Can Urol Assoc J 2014; 8:341-5. [PMID: 25408801 DOI: 10.5489/cuaj.2097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION We present our technique of laparoscopic nephrectomy for massive polycystic kidneys in patients with autosomal dominant polycystic kidney disease (ADPKD) and review the outcome analysis of our experience. METHODS We retrospectively reviewed all transperitoneal laparoscopic nephrectomies done for polycystic kidneys at a university hospital. Our technique included three 12-mm ports with additional one or two 5-mm ports, with usage of retraction devices, such as the Jarit PEER retractor (J. Jamner Surgical Instruments, Inc, Hawthorne, NY). RESULTS In total, 39 (left 14, right 25) laparoscopic nephrectomies were performed in 32 patients (male 21, female 11). Surgical indications were varied: to create space for future renal transplant in 21 (54%), to alleviate pain in 16 (41%), to prevent recurrent urosepsis in 2 (5%), to prevent recurrent bleeding which would require transfusions in 2 (5%) and to remove a renal tumour in 1 kidney (2.5%). Four patients had surgery for more than one reason. The mean age and body mass index were 52.2 years (range: 29-72) and 26.9 kg/m(2) (range: 21.6-34.0), respectively. The mean preoperative hemoglobin and serum creatinine levels were 131.6 g/L (range: 107-171) and 514 µmol/L (range: 84-923), respectively; 26 (81%) patients were on dialysis. The mean operative time and estimated blood loss were 185 minutes (range: 113-287) and 94 mL (range: 10-350), respectively. No patient required open conversion. The mean specimen size was 24.2 cm (range: 15-38); weight 1515 g (range: 412-4590) and the length of extraction incision was 9.2 cm (range: 6-13). There were 1 Grade 2 2 (2.5%), 2 Grade 3b (5%) and 1 Grade 4a-d (2.5%) complications. The mean length of stay was 4.5 days (range: 3-8). CONCLUSIONS Our technique of laparoscopic nephrectomy for massively enlarged polycystic kidneys in ADPKD is safe and offers all the advantages of minimal access surgery, such as smaller incision, decreased estimated blood loss, excellent cosmesis and faster recovery.
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Affiliation(s)
| | - Anil Kapoor
- McMaster Institute of Urology, St. Joseph's Healthcare, Hamilton, ON
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Wetmore JB, Calvet JP, Yu ASL, Lynch CF, Wang CJ, Kasiske BL, Engels EA. Polycystic kidney disease and cancer after renal transplantation. J Am Soc Nephrol 2014; 25:2335-41. [PMID: 24854270 PMCID: PMC4178444 DOI: 10.1681/asn.2013101122] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/15/2014] [Indexed: 01/07/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD), the most common form of polycystic kidney disease (PKD), is a disorder with characteristics of neoplasia. However, it is not known whether renal transplant recipients with PKD have an increased risk of cancer. Data from the Scientific Registry of Transplant Recipients, which contains information on all solid organ transplant recipients in the United States, were linked to 15 population-based cancer registries in the United States. For PKD recipients, we compared overall cancer risk with that in the general population. We also compared cancer incidence in PKD versus non-PKD renal transplant recipients using Poisson regression, and we determined incidence rate ratios (IRRs) adjusted for age, sex, race/ethnicity, dialysis duration, and time since transplantation. The study included 10,166 kidney recipients with PKD and 107,339 without PKD. Cancer incidence in PKD recipients was 1233.6 per 100,000 person-years, 48% higher than expected in the general population (standardized incidence ratio, 1.48; 95% confidence interval [95% CI], 1.37 to 1.60), whereas cancer incidence in non-PKD recipients was 1119.1 per 100,000 person-years. The unadjusted incidence was higher in PKD than in non-PKD recipients (IRR, 1.10; 95% CI, 1.01 to 1.20). However, PKD recipients were older (median age at transplantation, 51 years versus 45 years for non-PKD recipients), and after multivariable adjustment, cancer incidence was lower in PKD recipients than in others (IRR, 0.84; 95% CI, 0.77 to 0.91). The reason for the lower cancer risk in PKD recipients is not known but may relate to biologic characteristics of ADPKD or to cancer risk behaviors associated with ADPKD.
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Affiliation(s)
- James B Wetmore
- Department of Medicine, Division of Nephrology, The Kidney Institute,
| | - James P Calvet
- The Kidney Institute, Department of Biochemistry and Molecular Biology, and Department of Cancer Biology, University of Kansas School of Medicine, Kansas City, Kansas
| | - Alan S L Yu
- Department of Medicine, Division of Nephrology, The Kidney Institute
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Connie J Wang
- Department of Medicine, Division of Nephrology, The Kidney Institute
| | - Bertram L Kasiske
- Department of Medicine, Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota; and
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Asimakopoulos AD, Gaston R, Miano R, Annino F, Mugnier C, Dutto L, Vespasiani G, Spera E, Hoepffner JL, Piechaud T. Laparoscopic pretransplant nephrectomy with morcellation in autosomic-dominant polycystic kidney disease patients with end-stage renal disease. Surg Endosc 2014; 29:236-44. [PMID: 25125090 DOI: 10.1007/s00464-014-3663-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 05/31/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopic nephrectomy (LN) in end-stage autosomic-dominant polycystic kidney disease (ADPKD) requires a large abdominal incision for the specimen extraction. OBJECTIVE The objective of this study was to describe our technique of LN for end-stage ADPKD followed by morcellation (LNM) of the specimen and extraction through a minimal abdominal incision. METHODS The medical records of 19 consecutive patients who underwent pretransplant LNM between 2008 and 2011 by a single experienced laparoscopic surgeon were analyzed. Morcellation was performed with the Gynecare Morcellex™ Tissue morcellator, Ethicon. RESULTS AND LIMITATIONS All cases but one were completed laparoscopically. Mean specimen weight was 1,026.8 g. Mean duration of the procedure, estimated blood loss, and hospital stay were 131.3 min, 52.1 ml, and 7.9 days, respectively. Specimens were extracted through a 12-mm trocar in 10/18 patients and through a 3-cm incision in 9/18 cases. Postoperatively, three complications were observed (Clavien grades II, I, and II). The only case of incisional hernia was observed in the converted procedure. Major limitation of the study is its retrospective design. CONCLUSIONS In our preliminary series and in the hands of a very experienced laparoscopist, LNM for ADPKD appears as a modern, mini-invasive, and safe technique. Specimen's extraction through a small abdominal incision reduces postoperative pain and incisional hernias and guarantees the final cosmetic result of laparoscopy. The reduced overall morbidity could reduce the period between nephrectomy and transplantation.
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Affiliation(s)
- Anastasios D Asimakopoulos
- UOC of Urology, Department of Surgery, University of Rome Tor Vergata, Policlinico Casilino, Viale Oxford 81, 00133, Rome, Italy,
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ERBP Guideline on the Management and Evaluation of the Kidney Donor and Recipient. Nephrol Dial Transplant 2014; 28 Suppl 2:ii1-71. [PMID: 24026881 DOI: 10.1093/ndt/gft218] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Rodríguez-Faba O, Breda A, Villavicencio H. Renal transplantation and polycystic: surgical considerations. Actas Urol Esp 2014; 38:28-33. [PMID: 24099828 DOI: 10.1016/j.acuro.2013.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/08/2013] [Accepted: 06/02/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND The indication and timing of nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) remain controversial, especially in patients who are candidates to renal transplantation (RT). The main surgical options such as unilateral vs. bilateral nephrectomy, nephrectomy before vs. after RT, or simultaneous nephrectomy and transplantation, are herein discussed. OBJECTIVE Evidence acquisition of the best surgical management available for ADPKD in the context of kidney transplantation. ACQUISITION OF EVIDENCE Systematic literature review in PubMed from 1978 to 2013 was conducted. Articles selected included:randomized controlled trials and cohort studies. Furthermore, well designed ADPKD reviews were considered for this study. SYNTHESIS OF EVIDENCE Laparoscopic nephrectomy in ADPKD is a safe procedure with an acceptable complication rate. Unilateral nephrectomy has advantages over the bilateral one regarding the perioperative complication rate. Although the timing of nephrectomy is controversial, it seems that simultaneous nephrectomy and renal transplantation does not increase surgical morbidity neither affect graft survival. CONCLUSIONS Simultaneous nephrectomy and RT appears to be an acceptable alternative to conventional two-stage procedure without any increased morbidity, in the context of ADPKD. Furthermore, laparoscopic nephrectomy performed in experienced centres is a safe alternative to conventional approach.
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Tyson MD, Wisenbaugh ES, Andrews PE, Castle EP, Humphreys MR. Simultaneous kidney transplantation and bilateral native nephrectomy for polycystic kidney disease. J Urol 2013; 190:2170-4. [PMID: 23727414 DOI: 10.1016/j.juro.2013.05.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE Bilateral native nephrectomy with simultaneous kidney transplantation is becoming more common for patients with polycystic kidney disease in the living donor nephrectomy era. Single center reports evaluating the short-term and long-term outcomes of simultaneous kidney transplantation have been published but are generally limited by small sample sizes. We examined population level data to broadly define the complications of simultaneous kidney transplantation. MATERIALS AND METHODS The Nationwide Inpatient Sample (NIS) was used to acquire data on 2,368 patients with polycystic kidney disease treated with bilateral native nephrectomy between 1998 and 2010. We performed unadjusted, multivariable and propensity score adjusted analyses of postoperative outcomes. RESULTS A total of 2,368 patients were included in this study. The 271 patients (11.4%) who underwent simultaneous kidney transplantation had higher rates of intraoperative hemorrhage, blood transfusion and urological complications (propensity score adjusted OR 3.3, p=0.01, OR 4.2, p<0.0001 and OR 5.5, p<0.0001, respectively) but a lower in-hospital mortality rate (15.8% vs 1.1%, propensity score adjusted OR 0.10, p<0.0001). Median hospitalization was also significantly higher in patients who underwent simultaneous kidney transplantation (6 vs 9 days, p<0.0001). For the top quartile of high volume hospitals the rates of intraoperative hemorrhage, blood transfusion and urological complications remained statistically higher in patients treated with simultaneous kidney transplantation but in-hospital mortality was similar on multivariable logistic regression (OR 0.2, p=0.17). CONCLUSIONS Except for increased rates of intraoperative hemorrhage, blood transfusion and urological complications there were no significant differences in postoperative adverse outcomes in this large, population based study of patients who underwent simultaneous kidney transplantation compared to bilateral native nephrectomy alone.
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Affiliation(s)
- Mark D Tyson
- Department of Urology, Mayo Clinic, Phoenix, Arizona.
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Kidney transplantation with and without simultaneous bilateral native nephrectomy in patients with polycystic kidney disease: a comparative retrospective study. Transplantation 2012; 94:383-8. [PMID: 22828736 DOI: 10.1097/tp.0b013e31825812b9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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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Neeff HP, Pisarski P, Tittelbach-Helmrich D, Karajanev K, Neumann HPH, Hopt UT, Drognitz O. One hundred consecutive kidney transplantations with simultaneous ipsilateral nephrectomy in patients with autosomal dominant polycystic kidney disease. Nephrol Dial Transplant 2012; 28:466-71. [PMID: 23042709 DOI: 10.1093/ndt/gfs118] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Surgical management of autosomal dominant polycystic kidney disease (ADPKD) in patients awaiting renal transplantation is a challenging task. METHODS From 1998 to 2009, a total of 100 consecutive renal transplantations with simultaneous unilateral nephrectomy were performed in 59 men and 41 women with ADPKD and end-stage renal failure. About 38% received kidney allografts from living donors. The ipsilateral polycystic kidney was removed at the time of renal transplantation. Immunosuppressive therapy was not modified. Cold ischaemia time was 155 (38-204 min) versus 910 min (95-2760 min) for living versus deceased donor transplantation. Mean weight of removed kidneys was 2002 g (414-8850 g). Mean follow-up was 3.0 years (0.8-10.0 years). RESULTS Overall patient and graft survival were 97 and 96% at 1 year and 93 and 80% at 5 years, respectively. Serum creatinine at current follow-up was 1.49 (0.8-2.8) mg/dL. Surgical complications, which might be associated with simultaneous nephrectomy requiring re-operation, occurred in 12% (lymphocele 4%, hernia 4%, post-operative haematoma or bleeding 4%). None of the patients died peri-operatively. CONCLUSION Renal transplantation with simultaneous unilateral nephrectomy in ADPKD is a reasonable procedure for patients suffering from massively enlarged native kidneys.
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Affiliation(s)
- Hannes Philipp Neeff
- Department of General and Digestive Surgery, University of Freiburg, Freiburg i. Brsg., Germany.
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Sakai H, Ide K, Ishiyama K, Onoe T, Tazawa H, Hotta R, Teraoka Y, Yamashita M, Abe T, Hirata F, Morimoto H, Hashimoto S, Tashiro H, Ohdan H. Renal vein extension using an autologous renal vein in a living donor with double inferior vena cava: a case report. Transplant Proc 2012; 44:1446-9. [PMID: 22664033 DOI: 10.1016/j.transproceed.2011.11.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 11/23/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND When the kidney from a living donor with a double inferior vena cava (IVC) is harvested for renal transplantation, the short length of the renal vein may eventually create a technical problem for graft implantation. Herein, we have reported a rare case of renal vein extension using an autologous renal vein in a living donor with a double IVC. CASE REPORT A 70-year-old man with end-stage renal disease owing to autosomal-dominant polycystic kidney disease underwent a living donor kidney graft from his wife who had a double IVC. Because of the enlarged kidneys, the patient underwent a bilateral native nephrectomy with concomitant renal transplantation to create space in the pelvis. At nephrectomy, the recipient's renal vein was used to extend the donor renal vein. On the back table, the vein graft was sutured to the donor renal vein, permitting a 3.0-cm extension. RESULTS The transplantation was performed safely without any complications; the recipient's renal function and blood flow were excellent after the operation. CONCLUSION This case illustrated that an autologous renal vein graft is a preferable option to extend of short donor renal vein for recipients who require a simultaneous native nephrectomy.
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Affiliation(s)
- H Sakai
- Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Misumi T, Ide K, Onoe T, Banshodani M, Tazawa H, Teraoka Y, Hotta R, Yamashita M, Tashiro H, Ohdan H. Incidental renal cell carcinoma presenting in a renal transplant recipient with autosomal dominant polycystic kidney disease: a case report. J Med Case Rep 2012; 6:154. [PMID: 22691223 PMCID: PMC3423017 DOI: 10.1186/1752-1947-6-154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 03/29/2012] [Indexed: 11/26/2022] Open
Abstract
Introduction We report an instructive case of incidental renal cell carcinoma in a patient with autosomal dominant polycystic kidney disease who underwent simultaneous bilateral native nephrectomy and living donor renal transplantation. Case presentation A 57-year-old Asian man with end-stage kidney disease due to autosomal dominant polycystic kidney disease received a living kidney graft from his brother. Because of recurrent infection, chronic pain and enlarged kidneys, he underwent a bilateral nephrectomy with concomitant renal transplantation. The total weight of the removed kidneys was 6kg; the maximal diameter of the larger kidney was 28cm. His left kidney had a 1cm diameter tumor. Pathology indicated papillary renal cell carcinoma. At the time of this report, the transplant kidney function was normal with no evidence of local recurrence or distant metastasis. Conclusion This case shows and reinforces the importance of considering the possibility of an occult malignancy in the native kidneys of patients with autosomal dominant polycystic kidney disease. Simultaneous bilateral native nephrectomy should be considered in these renal transplant recipients not only for preventing the development of adverse symptoms but also for detecting an occult malignancy.
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Affiliation(s)
- Toshihiro Misumi
- Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8551, Japan.
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Kidney volume changes in patients with autosomal dominant polycystic kidney disease after renal transplantation. Transplantation 2012; 93:794-8. [PMID: 22491657 DOI: 10.1097/tp.0b013e318246f910] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Few studies have investigated whether the volume of native kidney and liver (when combined with polycystic disease) in patients with autosomal dominant polycystic kidney disease (ADPKD) decreases after renal transplantation. METHODS Changes in the volume of native kidney (bilateral: n=28; unilateral: n=5) and liver (concomitant polycystic disease: n=18) were analyzed in 33 patients with ADPKD, who underwent renal transplantation. Volumetry was retrospectively conducted using simple computed tomography scan data 6 months before transplantation, at the time of transplantation, and 1, 3, and 5 years after transplantation. Volume change was calculated on the basis of the value at the time of transplantation. RESULTS Mean±standard deviation values of bilateral native kidney volume were 3100±1417 (range: 756 to 6525; median: 2499) cm at the time of transplantation. Kidney volumes were significantly reduced in all but one patient after renal transplantation, decreasing by 37.7% and 40.6% at 1 and 3 years, respectively. The major proportion of the decrease was observed within the first year posttransplantation. In contrast, 16 of 18 patients showed significant increase of liver volumes after renal transplantation. The mean rates of increase were 8.6% and 21.4% at 1 and 3 years, respectively. CONCLUSIONS As the volume of native polycystic kidneys could be reduced after renal transplantation, resection would be unnecessary if the space for kidney graft is available in the absence of infection, bleeding, or malignancy. When ADPKD is combined with polycystic liver disease, the possibility of intolerable symptoms caused by growing liver cysts should also be taken into account.
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Patel P, Horsfield C, Compton F, Taylor J, Koffman G, Olsburgh J. Native nephrectomy in transplant patients with autosomal dominant polycystic kidney disease. Ann R Coll Surg Engl 2011; 93:391-5. [PMID: 21943464 DOI: 10.1308/003588411x582690] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION This study examined the clinical indications and timing for native nephrectomy (NN), together with the associated pathological findings in transplant patients with autosomal dominant polycystic kidney disease (ADPKD) at our institute over a period of 20 years. METHODS A retrospective review was performed of ADPKD patients who had undergone both kidney transplantation and NN. Patients were identified from the kidney transplant database between 1988 and 2008 at Guy's and St Thomas' Hospital and the notes reviewed. All NN specimens were re-reviewed and reported according to current guidelines. RESULTS There were 157 kidney transplants performed for ADPKD (114 cadaveric and 43 living donor). Of these, 31 required NN (28 bilateral). The timing of NN was pre-transplant in 10 cases, at the time of the transplant in 1 case and post-transplant in 20 cases. The indications for NN were urinary tract infection (n=14, 45%), pain (n=12, 39%), tumour suspicion (n=3, 10%), haematuria (n=1, 3%) and space (n=1, 3%). Mortality in this NN series was 3%, with a 65% surgical morbidity rate. The length of hospital stay post-NN was significantly longer with open compared with laparoscopic techniques (p=0.003). There were two renal cell carcinomas (RCCs) in this series. Both patients presented with macroscopic haematuria (bilateral pT1a papillary RCCs in one case and a pT3b clear cell RCC in the other case). The incidence of RCC in this series of ADPKD transplant patients was 1.3%. CONCLUSIONS We have demonstrated that the majority of ADPKD patients do not require NN, with only 20% of our series undergoing this procedure. The timing of NN is variable and dictated by indication. NN was only required to make space for transplantation in one case (combined kidney and pancreas transplant). The main indications for NN were recurrent infection and pain, where NN can provide a successful outcome. Laparoscopic NN can be performed safely in patients with ADPKD. Haematuria in such patients should not be assumed to be of benign origin and requires exclusion of urinary tract malignancy as the incidence of RCC in this population is at least as common as in the general population.
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Mitra S, Alangaden GJ. Recurrent urinary tract infections in kidney transplant recipients. Curr Infect Dis Rep 2011; 13:579-87. [PMID: 21870039 DOI: 10.1007/s11908-011-0210-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Urinary tract infections (UTIs) are the most common infectious complication after kidney transplantation (KT). Recurrent UTIs after KT can contribute to increased morbidity and may also be associated with graft loss and mortality. Though several risk factors like female gender, diabetes mellitus, presence of ureteric stents, native kidney disease with urological malformations and re-transplantation have been associated with recurrent UTIs after KT, vesicoureteric reflux appears to be a unique risk factor in this patient population. The emergence of drug-resistant pathogens as causative agents for post-transplant recurrent UTIs poses a significant therapeutic challenge. The use of pathogen-specific antibiotic therapy guided by culture and sensitivity data is warranted. The optimal duration of antimicrobial therapy for recurrent UTIs in renal transplant recipients remains uncertain.
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Affiliation(s)
- Subhashis Mitra
- Division of Infectious Diseases, Wayne State University School of Medicine, 3990 John R, Suite 5930, Detroit, MI, 48201, USA,
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Park UJ, Kim HT, Kim MY, Hwang EA, Han SY, Park SB, Kim HC, Kim YH, Cho WH. Successful Renal Transplantation in Patients with Polycystic Kidneys after Renal Contraction by Renal Artery Embolization - Report on 2 Cases. KOREAN JOURNAL OF TRANSPLANTATION 2011. [DOI: 10.4285/jkstn.2011.25.3.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ui Jun Park
- Department of Transplant & Vascular Surgery, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Hyoung Tae Kim
- Department of Transplant & Vascular Surgery, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Min Young Kim
- Department of Transplant & Vascular Surgery, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Eun Ah Hwang
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Seung Yeup Han
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Sung Bae Park
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Hyun Chul Kim
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Young Hwan Kim
- Department of Interventional Radiology, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Won Hyun Cho
- Department of Transplant & Vascular Surgery, Dongsan Medical Center, Keimyung University, Daegu, Korea
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Kirkman MA, van Dellen D, Mehra S, Campbell BA, Tavakoli A, Pararajasingam R, Parrott NR, Riad HN, McWilliam L, Augustine T. Native nephrectomy for autosomal dominant polycystic kidney disease: before or after kidney transplantation? BJU Int 2010; 108:590-4. [PMID: 21166760 DOI: 10.1111/j.1464-410x.2010.09938.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED Study Type - Therapy (case series). LEVEL OF EVIDENCE 4. What's known on the subject? and What does the study add? The indications and timing of native nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is controversial, especially for those undergoing renal transplantation. Post-transplant unilateral native nephrectomy appears to be the preferred intervention compared to pre-transplant native nephrectomy. There seems to be substantial additive risk to bilateral over unilateral nephrectomy, especially prior to transplantation. Pre-transplant native nephrectomy should only be carried out when there are clear indications such as massive size preventing allograft placement, severe pain, early satiety, recurrent bleeding and infections, or suspected malignancy. OBJECTIVE To analyse indications, timing and outcomes of native nephrectomy in autosomal dominant polycystic kidney disease (ADPKD) patients listed for kidney transplantation. PATIENTS AND METHODS A retrospective analysis of all ADPKD patients who had a native nephrectomy prior to or following transplantation between January 2003 and December 2009 at a single centre, including those undergoing the sandwich technique (removal of the most severely affected native kidney prior to transplantation, and the other afterwards), was undertaken. RESULTS There were 35 individuals in our cohort (M : F = 16 : 19), with a median age of 51.5 years (range 43-65). Twenty patients were in the pre-transplant nephrectomy group, 12 in the post-transplant group, and three underwent the sandwich technique. Indications for nephrectomy varied but were most commonly pain/discomfort, space for transplantation, ongoing haematuria, recurrent infections, and gastrointestinal pressure symptoms (early satiety). Seven individuals in the pre-transplant group and three in the post-transplant group required critical care admission after nephrectomy. Transient renal graft dysfunction occurred in two post-transplant bilateral nephrectomy patients. Two patients in the bilateral nephrectomy pre-transplant group and one in the bilateral nephrectomy post-transplant group died in the immediate post-operative period. No complications were noted in the sandwich technique group. CONCLUSION Native nephrectomy in ADPKD is a major undertaking associated with significant morbidity especially in the pre-transplant group. Post-transplant unilateral nephrectomy appears to be the safest approach with fewest complications.
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Affiliation(s)
- Matthew A Kirkman
- Renal and Pancreas Transplant Unit Department of Histopathology, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
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Staged Nephrectomy Versus Bilateral Laparoscopic Nephrectomy in Patients With Autosomal Dominant Polycystic Kidney Disease. J Urol 2010; 184:2054-9. [DOI: 10.1016/j.juro.2010.06.150] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Indexed: 11/15/2022]
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Cornelis F, Couzi L, Le Bras Y, Hubrecht R, Dodré E, Geneviève M, Pérot V, Wallerand H, Ferrière JM, Merville P, Grenier N. Embolization of polycystic kidneys as an alternative to nephrectomy before renal transplantation: a pilot study. Am J Transplant 2010; 10:2363-9. [PMID: 21143393 DOI: 10.1111/j.1600-6143.2010.03251.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In autosomal polycystic kidney disease, nephrectomy is required before transplantation if kidney volume is excessive. We evaluated the effectiveness of transcatheter arterial embolization (TAE) to obtain sufficient volume reduction for graft implantation. From March 2007 to December 2009, 25 patients with kidneys descending below the iliac crest had unilateral renal TAE associated with a postembolization syndrome protocol. Volume reduction was evaluated by CT before, 3, and 6 months after embolization. The strategy was considered a success if the temporary contraindication for renal transplantation could be withdrawn within 6 months after TAE. TAE was well tolerated and the objective was reached in 21 patients. The temporary contraindication for transplantation was withdrawn within 3 months after TAE in 9 patients and within 6 months in 12 additional patients. The mean reduction in volume was 42% at 3 months (p = 0.01) and 54% at 6 months (p = 0.001). One patient required a cyst sclerosis to reach the objective. The absence of sufficient volume reduction was due to an excessive basal renal volume, a missed accessory artery and/or renal artery revascularization. Embolization of enlarged polycystic kidneys appears to be an advantageous alternative to nephrectomy before renal transplantation.
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Affiliation(s)
- F Cornelis
- Department of Adult Diagnostic and Interventional Imaging, Bordeaux University Hospital, Place Amélie Raba Léon, Bordeaux, France
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