title: Simultaneous kidney transplantation and bilateral native nephrectomy for polycystic kidney disease.
abstract: OBJECTIVE
  Bilateral native nephrectomy with simultaneous kidney transplantation is becoming more common for patients with polycystic kidney disease in the living donor nephrectomy era. Single center reports evaluating the short-term and long-term outcomes of simultaneous kidney transplantation have been published but are generally limited by small sample sizes. We examined population level data to broadly define the complications of simultaneous kidney transplantation.
  
  
  METHODS
  The Nationwide Inpatient Sample (NIS) was used to acquire data on 2,368 patients with polycystic kidney disease treated with bilateral native nephrectomy between 1998 and 2010. We performed unadjusted, multivariable and propensity score adjusted analyses of postoperative outcomes.
  
  
  RESULTS
  A total of 2,368 patients were included in this study. The 271 patients (11.4%) who underwent simultaneous kidney transplantation had higher rates of intraoperative hemorrhage, blood transfusion and urological complications (propensity score adjusted OR 3.3, p=0.01, OR 4.2, p<0.0001 and OR 5.5, p<0.0001, respectively) but a lower in-hospital mortality rate (15.8% vs 1.1%, propensity score adjusted OR 0.10, p<0.0001). Median hospitalization was also significantly higher in patients who underwent simultaneous kidney transplantation (6 vs 9 days, p<0.0001). For the top quartile of high volume hospitals the rates of intraoperative hemorrhage, blood transfusion and urological complications remained statistically higher in patients treated with simultaneous kidney transplantation but in-hospital mortality was similar on multivariable logistic regression (OR 0.2, p=0.17).
  
  
  CONCLUSIONS
  Except for increased rates of intraoperative hemorrhage, blood transfusion and urological complications there were no significant differences in postoperative adverse outcomes in this large, population based study of patients who underwent simultaneous kidney transplantation compared to bilateral native nephrectomy alone.
authors.affiliation: Department of Urology, Mayo Clinic, Phoenix, Arizona. Electronic address: tyson.mark@mayo.edu.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Tyson
authors.forename: Eric S
authors.initials: ES
authors.lastname: Wisenbaugh
authors.forename: Paul E
authors.initials: PE
authors.lastname: Andrews
authors.forename: Erik P
authors.initials: EP
authors.lastname: Castle
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Humphreys
mesh_terms: D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D007690:Polycystic Kidney Diseases / Q000601:surgery*; D016896:Treatment Outcome
keywords: BNN; PKD; PS; SKT; bilateral native nephrectomy; kidney; kidney transplantation; nephrectomy; outcome assessment (health care); polycystic kidney disease; polycystic kidney diseases; propensity score; simultaneous kidney transplantation