Simultaneous nephrectomy during kidney transplantation for polycystic kidney disease does not detrimentally impact comorbidity and graft survival

Table 1 Donor and recipient characteristics of 154 kidney transplant recipients suffering from autosomal dominant polycystic kidney with or without associated ipsilateral nephrectomy during isolated kidney transplantation in a single center transplant program from January 2007 until January 2019

	KT alone group (n = 77)	KT with associated ipsilateral nephrectomy (n = 77)	P value
Donor characteristics
Age, yr	46.23 ± 14.94	47.40 ± 14.86	NS
Gender, male/female, n (%)	42/35 (54.5/45.5)	37/40 (48.1/51.9)	NS
CMV status, negative/positive, n (%)	32/43 (55.2/47.8)	26/47 (35.6/64.4)	NS
Type of donor, living/deceased donor, n (%)	6/71 (7.8/92.2)	21/56 (27.3/72.7)	a
Type of deceased donor, DBD/DCD, n (%)	54/17 (76.1/23.9)	38/18 (67.9/32.1)	NS
Recipient characteristics
Age, yr	57.40 ± 9.89	53.40 ± 9.12	NS
Gender, male/female, n (%)	48/29 (62.3/37.7)	47/30 (61.0/38.9)	NS
Body mass index, kg/m²	25.69 ± 4.00	25.33 ± 3.76	NS
Blood group, n (%)			NS
A	33 (42.9)	42 (54.5)	NS
B	5 (6.5)	4 (5.2)	NS
AB	0 (0)	3 (3.9)	NS
O	39 (50.6)	28 (36.4)	NS
Pretransplant dialysis versus preemptive kidney transplant, n (%)	65/12 (84.4/15.6)	55/22 (71.4/28.6)	NS
Residual urine diuresis before transplant, mL	1057.75 ± 852.84	1188.42 ± 818.65	NS
Rank of transplant			NS
First transplant, n (%)	73 (94.8)	76 (98.7)	NS
Second transplant, n (%)	3 (3.9)	1 (1.3)	NS
Third transplant, n (%)	1 (1.3)	0 (0)	NS
Time on dialysis before transplantation, d	1105 ± 1198	720 ± 757	NS
HLA Mismatching (MM), n (%)			NS
0 MM	11 (14.3)	6 (7.8)
1 MM	8 (10.4)	7 (9.1)
2 MM	30 (39.0)	16 (30.8)
3 MM	23 (29.9)	30 (39)
4 MM	2 (2.6)	7 (9.1)
5 MM	3 (3.9)	6 (7.8)
6 MM	0 (0.0)	5 (6.5)
Hemoglobin before transplantation, g/dL	12.47 ± 1.72	12.69 ± 1.18	NS
Albumin before transplantation, g/dL	4.32 ± 0.40	4.24 ± 0.41	NS
Peritransplant plasmapheresis treatment, n (%)	14 (18)	3 (4)	a

^aP < 0.05. Data are given as the mean ± SD. ADPKD: Autosomal dominant polycystic kidney disease; CMV: Cytomegalovirus; DBD: Donation after brain death; DCD: Donation after circulatory death; HLA: Human leukocyte antigen; KT: Kidney transplantation; MM: Mismatching; NS: No significance.

Table 2 Surgical data of 154 recipients suffering from autosomal dominant polycystic kidney disease with or without associated ipsilateral nephrectomy during isolated kidney transplantation in a single-center transplant program from January 2007 until January 2019

	KT alone group (n = 77)	KT with associated ipsilateral nephrectomy (n = 77)	P value
Indications for associated nephrectomy, n (%)
Creating space for graft positioning, n (%)		74 (96.1)
Pain, n (%)		29 (37.7)
Recurrent urinary tract infections, n (%)		11 (14.3)
Hematuria, n (%)		30 (39.0)
Digestive symptoms, n (%)		3 (3.9)
Lithiasis, n (%)		9 (11.7)
Anastomosis time1, min	39.61 ± 9.782	36.96 ± 10.10	NS
Cold ischemia time, min	827.56 ± 446.12	767.87 ± 436.81	NS
Total surgical time, min	169.07 ± 44.31	223.29 ± 71.96	a
Weight of removed native kidney, g		2073.94 ± 1197.89

¹Time from kidney out of ice water until moment of in vivo blood reperfusion.

^aP < 0.05. Data are given as the mean ± SD. ADPKD: Autosomal dominant polycystic kidney disease; NT: Not significant; KT: Kidney transplantation; NS: No significance.

Table 3 Surgical comorbidity and clinical outcomes of 154 isolated kidney transplant recipients suffering from autosomal dominant polycystic kidney disease with or without associated ipsilateral nephrectomy during transplantation in a single center transplant program from January 2007 until January 2019

	KT alone group (n = 77)	KT with associated ipsilateral nephrectomy (n = 77)	P value
Surgical comorbidity
Lymphocele, n (%)	5 (6.5)	7 (9.1)	NS
Wound infection, n (%)	6 (7.8)	2 (2.6)	NS
Incisional hernia, n%)	0 (0)	3 (3.9)	NS
Wound hematoma, n (%)	6 (7.8)	3 (3.9)	NS
Pulmonary embolism, n (%)	1 (1.3)	0 (0)	NS
Urinary infection, n (%)	14 (18.2)	8 (10.4)	NS
Need for blood transfusion, n (%)	22 (28.6)	34 (44.2)	NS
Hospital stay after transplantation, d	15.22 ± 6.662	14.81 ± 6.44	NS
Readmission rate during whole follow-up, n (%)	42 (46.2)	49 (63.6)	NS
Dindo Clavien classification			NS
Class I	36 (46.8)	33 (42.9)	NS
Class II	22 (28.6)	32 (41.6)	NS
Class III	7 (9.1)	3 (3.9)	NS
Class IV	12 (15.6)	9 (11.7)	NS
Clinical outcomes
Primary nonfunction, n (%)	0 (0)	2 (2.6)	NS
Delayed graft function, n (%)	7 (9.1)	13 (16.9)	NS
Renal artery thrombosis of kidney graft, n (%)	2 (2.6)	0 (0)	NS
Renal vein thrombosis of kidney graft, n (%)	2 (2.6)	0 (0)	NS
Acute rejection episode within 1 year after transplantation, n (%)	5 (6.5)	5 (6.5)	NS
Cellular, n (%)	5 (100)	2 (40)
Humoral, n (%)	0 (0)	3 (60)

Data are given as the mean ± SD. ADPKD: Autosomal dominant polycystic kidney disease; NT: Not significant; KT: Kidney transplantation; NS: No significance.

Table 4 Overview of studies investigating the surgical comorbidity of a simultaneous native unilateral or bilateral nephrectomy during isolated kidney transplantation for autosomal dominant polycystic kidney disease

Ref.	Study group (n)	Type of donor	Isolated KT with simultaneous native bilateral or unilateral nephrectomy		KT alone	Study conclusions
			Bilateral	Unilateral
Nunes P et al[13], 2007	1 (143)	LD (6%) + DD (94%)		+		Comparable overall complication rate and graft survival after 5 years if unilateral nephrectomy is performed for creation of space for a renal allograft
	2 (16)	LD (2%) + DD (98%)			+
Kramer A et al[14], 2009	1 (20)	LD (100%)	+			Minimal morbidity of an associated bilateral nephrectomy during transplantation and graft and patient survival of 100% during 5-year follow-up
Skauby MH et al[15], 2012	1 (79); 2 (78)	LD (100%)	+		+	Associated bilateral nephrectomy results in a longer hospital stay and more postoperative complications. No difference in 1- and 5-year patient and graft survival
Neeff HP et al[16], 2013	1 (100)	LD (38%) + DD (62%)		+		Routine ipsilateral nephrectomy, independent of volume of polycystic kidney, during transplantation is a safe procedure without endangering patient or graft survival. The death of 3 patients in the first year post-transplant is a concern
Ahmad SB et al[17], 2016	1 (66)	LD (100%)	+			In symptomatic patients with ADPKD, the combined procedure is advantageous, especially in terms of patient satisfaction
	2 (52)				+
Current study	1 (77)	LD (7.8%) + DD (92.2%)		+		Comparable surgical comorbidity and 1- and 5-year patient and graft survival
	2 (77)	LD (27.3%) + DD (72.7%)			+

ADPKD: Autosomal dominant polycystic kidney disease; DD: Deceased donor; LD: Living donor; KT: Kidney transplantation.