title: Simultaneous Native Nephrectomy and Kidney Transplantation in Patients With Autosomal Dominant Polycystic Kidney Disease.
abstract: BACKGROUND
  To evaluate the feasibility of simultaneous unilateral nephrectomy with kidney transplantation and to determine the effect of this procedure on perioperative morbidity and mortality and graft and patient survival.
  
  
  METHODS
  Between January 2000 and May 2015, 145 patients with autosomal dominant polycystic kidney disease (ADPKD) underwent kidney transplantation. Of those, 40 (27.5%) underwent concurrent ipsilateral native nephrectomy (group NT). Patients in group NT were compared with patients with ADPKD not undergoing concurrent nephrectomy (group NT-) and asymptomatic patients undergoing pretransplant nephrectomy (group PNT).
  
  
  RESULTS
  The average follow-up was 66 months. The graft survival rate at 1 and 5 years was 95% and 87.5% versus 93% and 76.2% in the NT and NT- groups, respectively (P = .903 and P = .544, respectively); 1-year patient survival was 100% for NT and 97% for NT- patients (P = .288), whereas 5-year patient survival was 100% and 92% for NT and NT- groups, respectively (P = .128). After propensity score matching (34 patients per group) no significant differences were observed in 1-year (97.1% in NT and 94.1%; P = 1) and 5-year (88.2% in NT and 91.2% in NT-; P = 1) graft survival, and in 1-year (100% for both groups; P = 1) and 5-year (100% in NT and 94.1% in NT-; P = 1) patient survival. Perioperative mortality was 0% among NT and 1.2% among NT- patients, whereas perioperative surgical complications were similar in both groups. One- and 5-year graft and patient survival were similar between the NT and PNT groups, but patients in the PNT group had significantly lower levels of hemoglobin and residual diuresis volumes at the time of transplant. Moreover, PNT patients had a longer pretransplant dialysis and a longer time on the waiting list.
  
  
  CONCLUSIONS
  Simultaneous unilateral nephrectomy does not have a negative effect on patient and graft survival in patients with ADPKD and is associated with low morbidity. Pretransplant nephrectomy should be restricted only to highly symptomatic patients, whereas unilateral nephrectomy in asymptomatic patients should be performed during kidney transplantation only if massive kidney size precludes graft positioning.
authors.affiliation: Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University Hospital of Catania, Via Santa Sofia, 84, 95123, Catania, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Veroux
authors.affiliation: Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University Hospital of Catania, Via Santa Sofia, 84, 95123, Catania, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Zerbo
authors.affiliation: Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University Hospital of Catania, Via Santa Sofia, 84, 95123, Catania, Italy.
authors.forename: Giusi
authors.initials: G
authors.lastname: Basile
authors.affiliation: Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University Hospital of Catania, Via Santa Sofia, 84, 95123, Catania, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Gozzo
authors.affiliation: Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University Hospital of Catania, Via Santa Sofia, 84, 95123, Catania, Italy.
authors.forename: Nunziata
authors.initials: N
authors.lastname: Sinagra
authors.affiliation: Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University Hospital of Catania, Via Santa Sofia, 84, 95123, Catania, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Giaquinta
authors.affiliation: Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University Hospital of Catania, Via Santa Sofia, 84, 95123, Catania, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Sanfiorenzo
authors.affiliation: Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University Hospital of Catania, Via Santa Sofia, 84, 95123, Catania, Italy.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Veroux
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000401:mortality*; D016891:Polycystic Kidney, Autosomal Dominant / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome