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2017 ; 31
(3
): 307-312
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Tailoring the Perfect Fit for Renal Transplant Recipients with End-stage
Polycystic Kidney Disease: Indications and Timing of Native Nephrectomy
#MMPMID28438856
Argyrou C
; Moris D
; Vernadakis S
In Vivo
2017[May]; 31
(3
): 307-312
PMID28438856
show ga
BACKGROUND: The ideal timing of native nephrectomy in relation to kidney
transplantation in patients with autosomal-dominant polycystic kidney disease
(ADPKD) can be a very puzzling decision for transplant surgeons and remains a
matter of debate. This review article aims to present current literature
regarding this highly controversial issue. MATERIALS AND METHODS: The
MEDLINE/PubMed database was searched using "polycystic kidney disease",
"renal/kidney transplantation" and "native nephrectomy" as key words. Our search
was focused on the optimal timing of and indications for native nephrectomy in
renal transplant recipients with ADPKD. RESULTS: In symptomatic cases,
pre-transplant unilateral or bilateral native nephrectomy seems appropriate, in
order to alleviate symptoms. In cases that are provided with the option of
living-donor transplantation, the performance of the simultaneous procedure could
be of benefit. When the principal indication of native nephrectomy is the
creation of space for the renal allograft, various studies highlight the safety
of the simultaneous approach of either unilateral or bilateral nephrectomy.
CONCLUSION: No consensus exists on the appropriate timing for native nephrectomy
in patients with ADPKD. Several issues to be addressed in the decision-making
process are the importance of residual diuresis, the longer operative time along
with the associated prolonged ischemia time and higher complication rate of the
combined procedure.