Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Urol. Mar 24, 2016; 5(1): 66-71
Published online Mar 24, 2016. doi: 10.5410/wjcu.v5.i1.66
Pre-transplant treatment of large polycystic kidney
Iván D Sáez, Juan F de la Llera, Andrés Tapia, Rodrigo A Chacón, Pedro A Figueroa, Bruno I Vivaldi, Alfredo Domenech, Christopher D Horn, Fernando Coz
Iván D Sáez, Juan F de la Llera, Andrés Tapia, Rodrigo A Chacón, Pedro A Figueroa, Bruno I Vivaldi, Alfredo Domenech, Christopher D Horn, Fernando Coz, Department of Urology, Military Hospital, Facultad de Medicina, Universidad de los Andes, Santiago 7850000, Chile
Author contributions: Sáez ID contributed to the literature search, revision, analysis and writing of the manuscript; de la Llera JF and Tapia A to the literature search, revision and writing of the manuscript; Chacón RA, Figueroa PA, Vivaldi BI and Domenech A contributed to the literature analysis and revision of the manuscript; Horn CD contributed to the literature search; Coz F contributed as head author.
Conflict-of-interest statement: There are no potential conflicts of interest. No financial support was received.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fernando Coz, MD, Professor, Chairman, Department of Urology, Military Hospital, Facultad de Medicina, Universidad de los Andes, Avenida Larraín 9100, Metropolitan Region, Santiago 7850000, Chile. dr.fcoz@gmail.com
Telephone: +56-2-23316982 Fax: +56-2-23317168
Received: August 28, 2015
Peer-review started: September 2, 2015
First decision: November 24, 2015
Revised: December 11, 2015
Accepted: January 16, 2016
Article in press: January 19, 2016
Published online: March 24, 2016
Processing time: 203 Days and 7.1 Hours
Abstract

AIM: To evaluate the indications, optimal timing and outcomes of native nephrectomy and other techniques in pretransplant treatment of autosomal dominant polycystic kidney disease (PKD).

METHODS: A literature review was conducted using the PubMed and Epistemonikos databases. Keywords for pre-transplant surgical management of polycystic kidneys were: Transplant, treatment and PKD. Keywords for pre-treatment embolization of PKD were: Embolization, transplant and polycystic kidney disease. The inclusion criterions were all articles found using this search method. The exclusion criterions were articles found to include bias and not attending pre-transplant treatment options. Fifteen articles were included in our final analysis. Ten articles were found regarding embolization of PKD of which three reviews were selected for final analysis. The reviews were divided into pre transplant and intra transplant treatment for the surgical treatment of PKD. All articles meeting inclusion criteria were thoroughly analyzed by two independent reviewers. A third independent reviewer was consulted if the reviewers did not agree upon the inclusion or exclusion of a specific article. No statistical analysis was performed.

RESULTS: Studies vary regarding the technique used (open or laparoscopic), laterality (single or bilateral) and temporality of nephrectomy with respect to renal transplant (pre-transplant or simultaneous to transplant). Several groups argue in favor of simultaneous nephrectomy and kidney transplant since it avoids the deleterious effects of being anefric. Long-term results and patient satisfaction are acceptable. However, it is associated with increased operative time, transfusion rate, morbidity and length of hospital stay. Based on small sample studies, bilateral nephrectomy prior to transplant has been associated with a higher risk of morbidity and mortality. Studies on laparoscopic approach report it as a feasible and safe alternative to the open surgery approach, highlighting its lower complication rate, transfusions and shorter hospital stay. Arterial embolization of the kidney appears as an effective and low morbid alternative for the management of large native kidneys. The reduction in renal size allow transplant in a significant number of patients, which makes it an appealing alternative to surgery.

CONCLUSION: There is limited evidence regarding best pretrasnplant treatment of large PKD but to date embolization seems an appealing alternative to augment space for renal graft allocation.

Keywords: Polycystic Kidneys; Kidney transplant; End stage renal disease; Kidney embolization

Core tip: Pre-transplant management of polycystic kidneys for patients with end-stage renal disease is unclear. A number of studies have advocated in favor of bilateral nephrectomy prior to transplant, others promote simultaneous nephrectomy and kidney transplant. Arterial embolization to reduce native kidney volume appears as an effective and attractive alternative.