Observational Study
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World J Transplant. May 18, 2022; 12(5): 100-111
Published online May 18, 2022. doi: 10.5500/wjt.v12.i5.100
Simultaneous nephrectomy during kidney transplantation for polycystic kidney disease does not detrimentally impact comorbidity and graft survival
Tom Darius, Sébastien Bertoni, Martine De Meyer, Antoine Buemi, Arnaud Devresse, Nada Kanaan, Eric Goffin, Michel Mourad
Tom Darius, Sébastien Bertoni, Martine De Meyer, Antoine Buemi, Michel Mourad, Surgical and Abdominal Transplantation Unit, University Clinics Saint Luc, Brussels 1200, Belgium
Arnaud Devresse, Nada Kanaan, Eric Goffin, Division of Nephrology, University Clinics Saint Luc, Brussels 1200, Belgium
Author contributions: Darius T and De Meyer M designed the research; Bertoni S, De Meyer M and Darius T performed the research; Darius T analyzed the data; Darius T wrote the paper.
Institutional review board statement: This study was approved by the Institutional Board of our University Hospital on July 6, 2020.
Informed consent statement: All study participants provided informed written consent regarding personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at tom.darius@uclouvain.be
STROBE statement: The manuscript was prepared according to the STROBE statement - checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Tom Darius, FRCS (Gen Surg), MD, PhD, Doctor, Professor, Surgeon, Surgical and Abdominal Transplantation Unit, University Clinics Saint Luc, Avenue Hippocrate 10, Brussels 1200, Belgium. tom.darius@uclouvain.be
Received: March 31, 2021
Peer-review started: March 31, 2021
First decision: July 29, 2021
Revised: August 11, 2021
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: May 18, 2022
Processing time: 407 Days and 6.5 Hours
ARTICLE HIGHLIGHTS
Research background

The lack of space, as an indication for a native unilateral nephrectomy for positioning a future kidney graft in the absence of other autosomal dominant polycystic kidney disease (ADPKD)-related symptoms, remains controversial.

Research motivation

Unilateral native nephrectomy to create space for graft positioning in an otherwise asymptomatic ADPKD patient is quite often routinely performed in isolated kidney transplant candidates before their activation on the waiting list. This strategy is mainly driven by the fear of increased surgical comorbidity and the possible negative impact of prolonged cold ischemia time and short- and long-term graft survival related to the associated nephrectomy during transplantation.

Research objectives

To evaluate the surgical comorbidity and the impact on graft survival of an associated ipsilateral native nephrectomy during isolated kidney transplantation in patients with ADPKD.

Research methods

One hundred and fifty-four kidney transplantations performed between January 2007 and January 2019 of which 77 without (kidney transplant alone (KTA) group) and 77 with associated ipsilateral nephrectomy (KTIN group), were retrospectively reviewed. Demographics and surgical variables were analyzed and their respective impact on surgical comorbidity and graft survival.

Research results

No significant difference in surgical comorbidity (lymphocele, wound infection, incisional hernia, wound hematoma, urinary infection, need for blood transfusion, hospitalization stay, Dindo Clavien classification and readmission rate) was observed between the two study groups. The 1- and 5-year graft survival were 94.8% and 90.3%, and 100% and 93.8%, respectively, in the KTA and KTIN group (P = 0.774). The 1- and 5-year patient survival were 96.1% and 92.9%, and 100% and 100%, respectively, in the KTA and KTIN group (P = 0.168).

Research conclusions

Simultaneous ipsilateral native nephrectomy to create space for graft positioning during kidney transplantation in patients with ADPKD does not negatively impact surgical comorbidity and short- and long-term graft survival.

Research perspectives

More kidney transplant candidates suffering from ADPKD when activated on the waiting list should be proposed for an associated ipsilateral nephrectomy during the transplantation instead of routinely programmed pretransplant nephrectomy.