Introduction: 50% of autosomal dominant polycystic kidney disease (ADPKD) patients will develop ESRD. For those patients who undergo renal transplantation (RT) and require a native nephrectomy (NN), the optimal timing of NN in relation to RT remains unknown.

Materials: We retrospectively reviewed 216 adult patients who underwent RT for ADPKD from 2005 to 2017. Patients were stratified by timing of NN into 2 groups. Group 1 included patients who had simultaneous NN and RT (n=102) & group 2 underwent NN prior to RT (n=26). Patients with post-transplant NN (n=5) and those not requiring NN (n=83) were excluded, leaving 128 patients for analysis.

Results: The median age for both groups was 52 (p=0.943) and 55% were male (p=0.095).

Regarding co-morbidities, 8/128 (6%) had DM at the time of transplant and 119/128 (93%) had HTN (p=0.696, 0.116, respectively). 36% of patients were symptomatic. The most common symptom was pain (25/46). Non-symptomatic patients underwent NN when the native kidney extended into the pelvis. Group 1 patients were more likely to be preemptive (47% vs. 0% [p<0.0001])and receive living donors (58% vs 29% [p=0.007]). Median EBL for Group 1 was 500 ml (IQR 300-900) vs 200 (IQR 150-388) for Group 2 (p<0.0001). Median operative time for transplant was 458 mins (IQR 351-565) for Group 1 vs. 363 mins (IQR 289-410) for Group 2 (p=0.034).

There were no differences in intraoperative complications (total rate 5.5%, p=0.169) or in post-op complications (20%, p=0.094). The most frequent post-op complication was ileus (28%). Median length of stay was 6 days for both groups (p=0.268). There was no difference in the readmission rate (p=0.81).

The most frequent reason for readmission was infection (22%). Median creatinine (Cr) at discharge was 1.7 (IQR 1.2-3.1) for Group 1 vs 2.5 (IQR 1.6-4.6) for Group 2 (p=0.027). Cr at one year was 1.4 (IQR 1.2-1.8) for Group 1 vs 1.6 (IQR 1.3-2.1) for Group 2 (p=0.08). Median graft survival was 146 months (IQR 56-235) vs 228 (IQR 106-300) for Groups 1 & 2, respectively (p=0.045).

Conclusions:

Patients who underwent simultaneous NN and KT had improved graft outcomes with no difference in perioperative complications. The differences in outcomes in these patients can likely be at least partially explained by the greater proportion of living donor recipients. Our results indicate that simultaneous surgery is safe despite longer operative times and greater blood loss.

CITATION INFORMATION: Eltemamy M., Crane A., Elmer-Dewitt M., Frainey B., Elshafei A., Wee A., Goldfarb D., Krishnamurthi V. Simultaneous versus Pretransplant Native Nephrectomy in Autosomal Dominant Polycystic Kidney Disease Patients Am J Transplant. 2017;17 (suppl 3).

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