Live Donor Renal Transplant With Simultaneous Bilateral Nephrectomy for Autosomal Dominant Polycystic Kidney Disease Is Feasible and Satisfactory at Long-term Follow-up.
BACKGROUND
Timing of bilateral nephrectomy (BN) is controversial in patients with refractory symptoms of autosomal dominant polycystic kidney disease (APKD) in need of a renal transplant.


METHODS
Adults who underwent live donor renal transplant (LRT) + simultaneous BN (SBN) from August 2003 to 2013 at a single transplant center (n = 66) were retrospectively compared to a matched group of APKD patients who underwent LRT alone (n = 52). All patients received general health and polycystic kidney symptom surveys.


RESULTS
Simultaneous BN increased operative duration, estimated blood loss, transfusions, intravenous fluid, and hospital length of stay. Most common indications for BN were pain, loss of abdominal domain, and early satiety. There were more intraoperative complications for LRT + SBN (6 vs 0, P = 0.03; 2 vascular, 2 splenic, and 1 liver injury; 1 reexploration to adjust graft positioning). There were no differences in Clavien-Dindo grade I or II (39% vs 25%, P = 0.12) or grade III or IV (7.5% vs 5.7%, P = 1.0) complications during the hospital course. There were no surgery-related mortalities. There were no differences in readmission rates (68% vs 48%, P = 0.19) or readmissions requiring procedures (25% vs. 20%, P = 0.51) over 12 months. One hundred percent of LRT + SBN allografts functioned at longer than 1 year for those available for follow-up. Survey response rate was 40% for LRT-alone and 56% for LRT + SBN. One hundred percent of LRT + SBN survey responders were satisfied with their choice of having BN done simultaneously.


CONCLUSIONS
Excellent outcomes for graft survival, satisfaction, and morbidity suggest that the combined operative approach be preferred for patients with symptomatic APKD to avoid multiple procedures, dialysis, and costs of staged operations.
1 Department of Surgery, University of Maryland School of Medicine, Baltimore, MD. 2 Division of Urology, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD. 3 School of Medicine, University of Maryland, Baltimore, MD. 4 Division of Nephrology, Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD. 5 Division of Transplantation Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Sarwat B
SB
Ahmad
Brian
B
Inouye
Michael S
MS
Phelan
Andrew C
AC
Kramer
Jay
J
Sulek
Matthew R
MR
Weir
Rolf N
RN
Barth
John C
JC
LaMattina
Eugene J
EJ
Schweitzer
David B
DB
Leeser
Silke V
SV
Niederhaus
Stephen T
ST
Bartlett
Jonathan S
JS
Bromberg
D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D005260:Female; D005440:Fluid Therapy; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D010359:Patient Readmission; D017060:Patient Satisfaction; D016891:Polycystic Kidney, Autosomal Dominant / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome