[Renal transplantation in patients with autosomal dominant polycystic kidney disease: pre-transplantation evaluation and follow-up].
Autosomal dominant polycystic kidney disease (ADPKD) which accounts for 15% of all renal transplantations emerges as the third cause of kidney transplantation in France. In addition to routine evaluation before transplantation, the ADPKD patient requires special assessment of three aspects: should potential kidney complications (recurrent upper tract infection or haemorrhage) or kidney size assessed by computed tomography require nephrectomy prior to transplantation? Is it advisable to detect intracranial aneurysm (ICA) in patients with a relative having experienced ruptured ICA? When transplantation from a living relative is considered, the existence of ADPKD in the donor should be formally ruled out by imaging or genetic studies. The risk of recurrence of ADPKD post-transplantation does not exist. Nevertheless other complications may occur. Thus, an increased incidence of colonic perforation has been reported. In addition, as compared to non-ADPKD patients, an increased risk for both skin cancer and new-onset post-transplant diabetes mellitus has been reported recently after kidney transplantation. Finally, because these patients suffer from an inherited syndrome, physicians should carefully consider the personal and familial history before and after transplantation in order to respond to fatalism in some cases, or to attenuate excessive enthusiasm in the others. Altogether, it apears that a specific approach is needed for ADPKD patients when considering renal transplantation.
Service de néphrologie-immunologie clinique, CHU de Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France.
Anne
A
Bretagnol
Matthias
M
Büchler
Jean-Michel
JM
Boutin
Hubert
H
Nivet
Yvon
Y
Lebranchu
Dominique
D
Chauveau
D000359:Aftercare; D003108:Colonic Diseases / Q000453:epidemiology / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology; D005192:Family Health; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000235:genetics; D016030:Kidney Transplantation; D016031:Liver Transplantation; D009392:Nephrectomy; D016891:Polycystic Kidney, Autosomal Dominant / Q000453:epidemiology / Q000235:genetics / Q000523:psychology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011300:Preoperative Care; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000453:epidemiology / Q000209:etiology; D009927:Tissue and Organ Procurement