Bilateral nephrectomy with concomitant renal graft transplantation for autosomal dominant polycystic kidney disease

Purpose: There has been controversy about pre-transplant nephrectomy in pat ients with autosomal dominant polycystic kidney disease. Kidneys may be rem oved in these patients when they cause respiratory compromise, early satiet y, increased abdominal girth, pain, hematuria or recurrent infection. We de termined whether concomitant bilateral nephrectomy at renal transplantation is safe and efficacious. Materials and Methods: Between December 1996 and January 1999, 10 patients with autosomal dominant polycystic kidney disease underwent bilateral nephr ectomy with concomitant renal grafting (group 1). We compared these patient s to 9 with autosomal dominant polycystic kidney disease matched for age an d gender who underwent transplantation only (group 2) and 4 with the same c ondition who underwent bilateral nephrectomy and renal transplantation as s taged procedures (group 3). Results: No patients died perioperatively. There was a lower rate of compli cations in group 1 than in groups 2 or 3. The only significant differences in intraoperative and perioperative parameters were operative time and intr aoperative blood loss, which were greater in group 1 than in group 2. We no ted no significant differences in groups 1 and 3. Patient satisfaction anal yzed by a survey revealed that the 70% of group 1 patients who responded we re satisfied with kidney removal and 7 of the 9 in group 2 desired native k idney removal. All group 3 patients already had a functioning renal graft b ut were satisfied with native kidney removal, although they would rather ha ve undergone bilateral nephrectomy at transplantation. Conclusions: Our data imply that there is no higher morbidity or mortality when performing concomitant bilateral nephrectomy at renal transplantation in patients with renal failure due to autosomal dominant polycystic kidney disease. There was a higher rate of satisfaction in patients who underwent nephrectomy and transplantation simultaneously, while those who did not und ergo concomitant procedures strongly desired to have had that option. Bilat eral nephrectomy may alleviate symptoms while providing greater room for re nal graft placement. When done without transplantation, bilateral nephrecto my resulted in the highest number of complications. Our data indicate that if bilateral nephrectomy is performed as an adjunct to transplantation, it should be done at renal grafting.