title: Experience with autosomal dominant polycystic kidney disease in patients before and after renal transplantation: a 7-year observation.
abstract: OBJECTIVE
  Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the presence of multiple cysts in both kidneys. Symptoms of the disease may arise either from the presence of cysts or from increasing loss of kidney function. First symptoms usually appear in the third decade of life: lumbar pain, urinary tract infections, arterial hypertension, or renal colic due to cyst rupture or coexistent nephrolithiasis. An early diagnosis, male gender, large kidneys by sonography, arterial hypertension, hematuria, and urinary tract infections are predictive factors of a faster progression of the disease. Our aim was to establish the indications for nephrectomy among symptomatic ADPKD patients before kidney transplantation and to assess the risks of posttransplantation complications among ADPKD patients without nephrectomy.
  
  
  METHODS
  The observed group consisted of 183 patients with ADPKD among whom 50 (27.3%) underwent kidney transplantation during a 7-year observation period (2000-2007). Among those subjects were 3 groups: (I) nephrectomy preceding transplantation; (II) nephrectomy during kidney transplantation; and (III) without nephrectomy.
  
  
  RESULTS
  Among group I before transplantation we observed: arterial hemorrhage, wound infections, and splenectomy 4 weeks after ADPKD nephrectomy; afterward we observed: urinary tract infections and contralateral cyst infection. Among group II we only observed 1 case of wound infection. Among group III we observed: ascending urinary tract infections, cyst infections, and cyst hemorrhage. Cyst hemorrhage and cyst infections led mainly to ADPKD kidney nephrectomy. During the observation time, 80.95% of grafts were functioning.
  
  
  CONCLUSIONS
  Unilateral nephrectomy is a well-founded preliminary surgical treatment before kidney transplantation. Bilateral nephrectomy before or during transplantation eliminates ADPKD complications and does not significantly increase general complications. The greatest numbers of complications and of graft losses were observed among the group without pretransplantation nephrectomy.
authors.affiliation: Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland. sulikowskit@wp.pl
authors.forename: T
authors.initials: T
authors.lastname: Sulikowski
authors.forename: K
authors.initials: K
authors.lastname: Tejchman
authors.forename: Z
authors.initials: Z
authors.lastname: Zietek
authors.forename: J
authors.initials: J
authors.lastname: Rózański
authors.forename: L
authors.initials: L
authors.lastname: Domański
authors.forename: M
authors.initials: M
authors.lastname: Kamiński
authors.forename: J
authors.initials: J
authors.lastname: Sieńko
authors.forename: M
authors.initials: M
authors.lastname: Romanowski
authors.forename: M
authors.initials: M
authors.lastname: Nowacki
authors.forename: K
authors.initials: K
authors.lastname: Pabisiak
authors.forename: M
authors.initials: M
authors.lastname: Kaczmarczyk
authors.forename: K
authors.initials: K
authors.lastname: Ciechanowski
authors.forename: A
authors.initials: A
authors.lastname: Ciechanowicz
authors.forename: M
authors.initials: M
authors.lastname: Ostrowski
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003560:Cysts / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D013997:Time Factors; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents