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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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Huynh N, Yoon P, Hort A, Yao J, Lee T, Yuen L, Laurence JM, Pleass H. Utilizing the same incision for staged renal transplant in patients with polycystic kidney disease requiring hand-assisted laparoscopic nephrectomy. ANZ J Surg 2022; 92:3004-3010. [PMID: 36128601 DOI: 10.1111/ans.18038] [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: 06/01/2022] [Revised: 08/01/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS Many autosomal dominant polycystic kidney disease (ADPKD) patients undergo nephrectomy and subsequent renal transplantation. We report our outcomes after hand-assisted laparoscopic nephrectomy (HALN) where a Rutherford-Morrison incision is used as a hand-port site and kidney extraction site, as well the future incision site for staged transplantation. METHODS A retrospective review was performed on all adult nephrectomies for ADPKD by the Transplant Surgery department at Westmead Hospital between June 2011 and June 2021. Outcomes were compared between HALN, laparoscopic nephrectomy (LN) and open nephrectomy (ON) including operation time, hospital length of stay (LOS), post-operative complications, subsequent transplantation and post-transplantation wound complications. RESULTS Twenty-two HALN, 8 LN and 5 ON were performed during the study period. Median kidney weights for HALN, LN and ON were significantly different (1575, 403, 3420 g respectively, P = 0.001). There was a significant difference in LOS between the HALN and ON (5.8 versus 9.8 days, P = 0.04), but not between HALN and LN (5.8 versus 5.1, P = 0.06). There was no significant difference for operation time (P = 0.34) and major complication rates (P = 0.58). There were 8 HALN, 5 LN and 2 ON who have had subsequent renal transplantation with one wound complication, an incisional hernia in the HALN group. CONCLUSION Our HALN is associated with a shorter LOS and similar complication rate to ON and can be efficiently performed for significantly larger kidneys than LN without a significant difference in operation time or LOS. The same Rutherford-Morrison incision site can be used for transplantation.
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Affiliation(s)
- Nguyen Huynh
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Yoon
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy Hort
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia
| | - Jinna Yao
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia
| | - Taina Lee
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia
| | - Lawrence Yuen
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia
| | - Jerome Martin Laurence
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Henry Pleass
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Gadelkareem RA, Abdelgawad AM, Mohammed N. Simultaneous kidney transplantation and ipsilateral native nephrectomy in patients with autosomal dominant polycystic kidney disease. World J Transplant 2022; 12:310-312. [PMID: 36187882 PMCID: PMC9516487 DOI: 10.5500/wjt.v12.i9.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/14/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
The simultaneous kidney transplantation and ipsilateral native nephrectomy for autosomal dominant polycystic kidney disease does not seem to be associated with increased rates of comorbidity and complications. This outcome can efficiently be achieved when the indication and surgical approach of native nephrectomy are properly justified.
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Affiliation(s)
- Rabea Ahmed Gadelkareem
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Amr Mostafa Abdelgawad
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Nasreldin Mohammed
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
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