Background: Many strategies regarding timing of native nephrectomies exist for patients with symptomatic polycystic kidney disease (PCKD). We hypothesize that the timing of bilateral nephrectomies has no influence on graft survival or surgical morbidity.

Methods: This is a retrospective study of 522 adults with PCKD who had renal transplants at a single center from 1994-2015. Three groups were analyzed: renal transplant-only recipients (RTO), recipients of simultaneous bilateral nephrectomies and transplant (SBN), and recipients with pre-transplant bilateral nephrectomies (PTBN). The primary outcome was graft survival. Secondary outcomes included post-operative complications.

Results: 522 adults with PCKD received kidney transplants: 334 (64.0%) had RTO, 157 (30.1%) had SBN with intra-peritoneal placement of the transplant, and 31 (5.9%) had PTBN. 10 year actuarial post-transplant graft survival was 67.6%, 62.7% and 69.1% for RTO, PTBN and SBN respectively (p=0.82). Further, no statistically significant differences were observed in rates of post-operative ileus, deep vein thrombosis, small bowel obstruction, urinary stricture, urine leak, hernia formation, urinary tract infection, and delayed graft function. More wound complications were seen in PTBN patients (29.0% vs 13.5% RTO, 10.2% SBN; p=0.03) while SBN patients had a lower incidence of lymphocele (1.3% vs 9.3% RTO, 9.7% PTBN; p=0.03). Importantly, SBN patients had more renal vascular thromboses (5.7% vs 1.8% RTO, 0% PTBN; p=0.005). Only 38 RTO patients (11.4%) eventually required post-transplant nephrectomies.

Conclusions: SBN can be safely performed at the time of renal transplantation and does not adversely affect long-term graft survival rates. Interestingly, the rate of early renal vascular thrombosis was higher compared to the other two groups wherein the transplant is placed retroperitoneal. Though the simultaneous approach was associated with a lower incidence of lymphocele formation and, along with RTO, a lower incidence of wound complications, before it can be endorsed the association with early graft thromboses needs to be further examined.

CITATION INFORMATION: Grodstein E, Kaufman D. A Retrospective Study of Simultaneous Bilateral Nephrectomies and Renal Transplantation in Recipients with Polycystic Kidney Disease. Am J Transplant. 2016;16 (suppl 3).

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