Kidney transplantation in patients with autosomal dominant polycystic kidney disease: surgical tactics, immediate and long-term outcomes

Treatment and kidney transplantation (KT) for patients with autosomal dominant polycystic kidney disease (ADPKD) are associated with increased risks, particularly due to the potential for infection of polycystic kidney (PK) cysts. Currently, no standardized guidelines exist for the surgical management and pre-transplant preparation of these patients.

Objective: to analyze the 15-year experience at a transplant center managing KT recipients with end-stage chronic kidney disease (eCKD) due to ADPKD.

Materials and methods. A retrospec- tive and prospective analysis was conducted on 132 ADPKD patients who underwent staged surgical treatment between 2008 and 2023. In the first stage, outcomes of 155 PK nephrectomies performed via laparoscopic and open approaches were evaluated. In the second stage, KT outcomes were assessed in 63 ADPKD recipients, com- paring those with preserved native kidneys to those who had undergone nephrectomy. Additionally, as a control group, KT outcomes in 129 patients with eCKD of other etiologies from 2013 to 2023 were analyzed.

Results. The study revealed significant advantages of laparoscopic access for PK nephrectomy, including a shorter length of stay in both intensive care and the hospital, as well as a lower complication rate (47.8% for laparotomy and lumbotomy approaches, and 12.8% for laparoscopic access). However, patients who underwent KT with preser- ved PK exhibited a higher incidence of infectious complications (26.9%), primarily due to cyst infections and resistance to standard antibiotic prophylaxis. Long-term graft survival was notably lower in this group, with a ten-year survival rate of 46.2%, compared to 73.1% in patients who had undergone nephrectomy and 74.1% in the comparison group.

Conclusion. The integration of laparoscopic surgery for polycystic kidney disease into clinical practice has the potential to significantly reduce surgical complications and broaden the indications for PK nephrectomy. Among ADPKD patients who underwent nephrectomy, the post-transplant period was more favorable, with outcomes comparable to those of KT recipients with eCKD of other etiologies.

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