title: [Place of nephrectomy in patients with autosomal dominant polycystic kidney disease waiting for renal transplantation].
abstract: OBJECTIVE
  To define the indications, results and place of nephrectomy for autosomal dominant polycystic kidney disease (ADPKD) in relation to renal transplantation.
  
  
  METHODS
  Between October 1998 and February 2006, 145 patients with ADPKD were followed in our institution; 38 of them underwent nephrectomy via a subcostal incision, mainly in preparation for renal transplantation. The decision to perform nephrectomy in preparation for renal transplantation was based on clinical examination and CT findings.
  
  
  RESULTS
  Indications for nephrectomy were preparation for renal transplantation (n=28, 68%), severe urological complications (n=12) and malignant tumour (n=1). Forty-one nephrectomies were performed, pretransplantation in 36 cases (88%) and five post-transplantation nephrectomies in three patients. The nephrectomy rate was 26%. The median kidney weight was 2800 grams. The mean operating time was 100 minutes and mean blood loss was 76 ml. The overall morbidity was 36.6% with 7.3% of serious complications. The mean hospital stay was 14.5 days. No patient nephrectomized before transplantation (n=13) developed any complications of the contralateral native kidney with a mean follow-up of 33 months. The mean interval between initiation of dialysis and transplantation and between nephrectomy and transplantation was 30 and 16 months, respectively.
  
  
  CONCLUSIONS
  The optimal timing and incision for nephrectomy for ADPKD are still a subject of debate. In the absence of urological complications, nephrectomy, associated with considerable morbidity, should only be performed when very large kidneys truly interfere with graft implantation. Systematic unilateral or bilateral nephrectomy must therefore no longer be proposed. To avoid the complications of the anephric state, it is preferable to wait, whenever possible, until the patient is placed on dialysis, but the development of pre-emptive transplantation raises the issue of concomitant nephrectomy and transplantation, which may be a feasible option.
authors.affiliation: Service d'urologie, hôpital Necker, 149, rue de Sèvres, 75743 Paris cedex 15, France. daniel.cohen@nck.aphp.fr
authors.forename: D
authors.initials: D
authors.lastname: Cohen
authors.forename: M-O
authors.initials: MO
authors.lastname: Timsit
authors.forename: Y
authors.initials: Y
authors.lastname: Chrétien
authors.forename: N
authors.initials: N
authors.lastname: Thiounn
authors.forename: V
authors.initials: V
authors.lastname: Vassiliu
authors.forename: M-F
authors.initials: MF
authors.lastname: Mamzer
authors.forename: C
authors.initials: C
authors.lastname: Legendre
authors.forename: A
authors.initials: A
authors.lastname: Méjean
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D016891:Polycystic Kidney, Autosomal Dominant / Q000601:surgery*; D012189:Retrospective Studies