title: Native Nephrectomy in Renal Transplant Recipients with Autosomal Dominant Polycystic Kidney Disease.
abstract: BACKGROUND
  Native nephrectomy (NNx) is often done in patients with autosomal dominant polycystic kidney disease (ADPKD). Controversy exists concerning the need and timing of nephrectomy in transplant candidates. We hypothesize that post-transplant NNx does not negatively impact patient and graft survival.
  
  
  METHODS
  Among 470 ADPKD transplant recipients included in the study, 114 (24.3%) underwent pre- (30.7%) or post-transplant (69.3%) NNx. Clinical data was retrieved from electronic records. Follow up was until death, graft loss or June 2014. Perioperative complications were compared between the surgical techniques (open or laparoscopic) and between the pre- and post-transplant nephrectomy groups. The effect of nephrectomy on graft survival was analyzed as a time-dependent covariate when performed post-transplant.
  
  
  RESULTS
  Mean age at transplant was 52.4 years, 53.8% were male, 93% white, 70% were from living donors and 56.8% were pre-emptive. Nephrectomy was done laparoscopically in 31% and 86% in the pre- and post- transplant nephrectomy groups, respectively. Complications were less common in those who underwent nephrectomy post-transplant (26.6% vs. 48%, p=0.03) but were similar regardless of surgical technique (open, 33.3% vs. laparoscopic 33%, p=0.66). Patient and graft survival were similar between those who underwent pre-transplant nephrectomy and the rest of the recipients. In the post-transplant nephrectomy group, nephrectomy did not affect patient (HR 0.77, CI 0.38-1.54, p=0.45) or graft survival (HR 1.0, CI 0.57-1.76, p=0.1).
  
  
  CONCLUSIONS
  Nephrectomy does not adversely affect patient or graft survival. Post-transplant nephrectomy is feasible when indicated without compromising long term graft outcome and has fewer complications than pre-transplant nephrectomy.
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension.
authors.forename: Fouad T
authors.initials: FT
authors.lastname: Chebib
authors.affiliation: William von Liebig Transplant Center.
authors.forename: Mikel
authors.initials: M
authors.lastname: Prieto
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension; Kosin University College of Medicine, Busan, South Korea.
authors.forename: Yeonsoon
authors.initials: Y
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension.
authors.forename: Maria V
authors.initials: MV
authors.lastname: Irazabal
authors.affiliation: William von Liebig Transplant Center; Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kremers
authors.affiliation: William von Liebig Transplant Center.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Dean
authors.affiliation: Department of Surgery, Southern Illinois University, Springfield, Illinois, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Rea
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension; William von Liebig Transplant Center.
authors.forename: Fernando G
authors.initials: FG
authors.lastname: Cosio
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension.
authors.forename: Vicente E
authors.initials: VE
authors.lastname: Torres
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension.
authors.forename: Ziad M
authors.initials: ZM
authors.lastname: El-Zoghby