title: Selective, concurrent bilateral nephrectomies at renal transplantation for autosomal dominant polycystic kidney disease.
abstract: OBJECTIVE
  An algorithm was developed for performing bilateral nephrectomies for specific indications before or at renal transplantation in patients with autosomal dominant polycystic kidney disease. Outcomes for the living donor arm of the algorithm are reported.
  
  
  METHODS
  Patients with autosomal dominant polycystic kidney disease and end stage renal disease were evaluated for transplantation. Patients with recurrent pyelonephritis, hemorrhage, pain, early satiety or kidneys that extended into the true pelvis underwent bilateral nephrectomies. Bilateral nephrectomies with concurrent renal transplantation were performed if a living renal donor was identified. If no living donor was identified, pre-transplantation bilateral nephrectomies were done and the patients were listed for cadaveric donor renal transplantation. The living renal donor arm of the algorithm was evaluated by comparing certain parameters for 15 and 17 patients with autosomal dominant polycystic kidney disease who underwent pre-transplantation and concurrent bilateral nephrectomies, respectively, including patient and graft survival, delayed graft function, graft function, length of stay for each surgery, transfusions and complications.
  
  
  RESULTS
  No deaths, graft failures or delayed graft function occurred. In the delayed renal transplant group median time from nephrectomy to living donor transplantation was 124 days. Serum creatinine at discharge home and 1 year after transplantation for the pre-transplantation nephrectomy cohort was 2.0 and 1.3 mg/dl, respectively. Seven of the 17 patients with concurrent nephrectomy underwent transplantation before starting renal replacement therapy. A longer mean total hospital stay in the pre-transplantation nephrectomy cohort was the only statistically significance outcome variable.
  
  
  CONCLUSIONS
  Selective bilateral nephrectomies at living donor renal transplantation results in decreased total length of stay without compromising patient or graft outcomes and it allows preemptive renal transplantation. Concurrent nephrectomy is safe and it further validates the algorithm for selective, concurrent bilateral nephrectomies for patients with autosomal dominant polycystic kidney disease who undergo living donor renal transplantation.
authors.affiliation: Division of Urology and Renal Transplantation, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA. wagnerm@ohsu.edu
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Wagner
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Prather
authors.forename: John M
authors.initials: JM
authors.lastname: Barry
mesh_terms: D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D016891:Polycystic Kidney, Autosomal Dominant / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome