This study found that only some autosomal dominant polycystic kidney disease (ADPKD) patients need a native nephrectomy in the context of a restrictive nephrectomy policy in the workup for kidney transplantation.
This study indicates that with a restrictive nephrectomy policy in the workup for kidney transplantation, only some autosomal dominant polycystic kidney disease (ADPKD) patients need a native nephrectomy. There is no consensus if nor when a native nephrectomy should be performed in the workup for kidney transplantation in ADPKD patients. In the authors’ PKD Expertise Center, a restrictive approach is pursued in which nephrectomy is performed only in patients with severe complaints, i.e., in case of serious volume-related complaints, lack of space for the allograft, recurrent cyst infections, persistent cyst bleedings, or chronic refractory pain. The authors analyzed in a retrospective cohort study whether this approach is justified. All ADPKD patients who received kidney transplantation between January 2000 and January 2019 were reviewed. Patients were subdivided into three groups: no nephrectomy (no-Nx), nephrectomy performed before (pre-Tx), or after kidney transplantation (post-Tx). Simultaneous nephrectomy together with transplantation were not performed in the center. The study included 391 patients (54 ± 9 years, 55% male). The majority of patients did not undergo a nephrectomy (n = 257, 65.7%). A nephrectomy was performed pre-Tx in 114 patients (29.2%). After Tx, nephrectomy was performed in only 30 patients (7.7%, median 4.4 years post-Tx). Surgery-related complication rates did not differ between both groups (38.3% pre-Tx vs. 27.0% post-Tx, p = 0.2), nor were there any differences in 10-year patient survival (74.4% pre-Tx vs. 80.7% post-Tx vs. 67.6% no-Nx, p = 0.4), as well as in 10-year death-censored graft survival (84.4% pre-Tx vs. 85.5% post-Tx vs. 90.0% no-Nx, p = 0.9).