Outcomes of Pretransplant Nephrectomy for Autosomal Dominant Polycystic Kidney Disease Patients

Background: For individuals with end-stage renal disease (ESRD), renal transplantation (RTx) is the most effective replacement therapy to guarantee a good quality life. Autosomal dominant polycystic kidney disease (ADPKD), a genetic disorder, is a rare cause for ESRD but presents unique pretransplant challenges. This study evaluates the outcomes of pretransplant native nephrectomy in patients with ADPKD undergoing live donor RTx. It represents a single center retrospective series evaluating the indications, surgical approach, postoperative complications, and timings of pretransplant nephrectomy in ADPKD patients in a developing country setting. Materials and Methods: We retrospectively analyzed the clinical data from 29 ADPKD patients who underwent pretransplant native nephrectomy between 2007 and 2023, followed by live donor RTx. Data collected included demographics, indications for nephrectomy, surgical approach, and postoperative outcomes including graft and patient survival. Results: Of the 29 patients, 26 (89.6%) were male; 55.1% had hypertension and 3.4% had diabetes. Presenting symptoms included hematuria (27.6%), recurrent urinary tract infections (20.6%), and asymptomatic presentations (31%). The primary indication for native nephrectomy was graft implantation obstruction due to enlarged kidneys (41.3%). Laparoscopic nephrectomy was performed in 93.1% of cases. The mean hemoglobin drop in the postoperative period was 0.6 ± 0.2 g/dL. Complications included fluid collections (five patients), prolonged ileus (9), and prolonged drain output (4). At a median follow-up, 86.2% (25/29) had functional grafts. Three patients died posttransplant (10, 14, and 42 months), due to infection (2) and cardiac event (1). Conclusions: Majority of ADPKD patients required pretransplant nephrectomy for a size-related issue. Laparoscopic native nephrectomy can be safely performed in these patients and its timing is variable and dictated by indication.