Theory and Practice in Medicine, 2015, Vol. 21, No. 2.2
AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE – CHANGES IN NATIVE KIDNEY SIZE AND NATIVE NEPHRECTOMY EFFECT ON KIDNEY GRAFT FUNCTION, POSTRANSPLANT MORBIDITY AND OVERALL SURVIVAL
Katažyna Polubenko, Agnė Laučytė-Cibulskienė, Albertas Čekauskas, Marius Miglinas, Feliksas Jankevičius
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Key words: autosomal dominant polycystic kidney disease, nephrectomy, transplantation.
Objective. To investigate the impact of pre-transplant nephrectomy in patients with autosomal dominant polycystic kidney disease by analysing post-transplant outcomes and native kidney size changes. To determine if pre-transplant nephrectomy is associated with better prognosis of autosomal dominant polycystic kidney disease.
Materials and methods. A retrospective study of 739 patients who underwent kidney transplantation in previous 14,5 years was conducted. 53 patients with autosomal dominant polycystic kidney disease were selected. 50 of them were enrolled into the final study. They were divided into two groups: A group – native pre-transplant nephrectomy was performed, B group – native pre-transplant nephrectomy was not performed. SPSS 20.0 software was used for statistical analysis (P values were considered significant if < 0.05).
Results. A group consisted of 26 patients, B group – 24. No significant differences were found between groups with regard to demographic characteristics, time spent on dialysis before transplantation, donor type, graft failure and transplant function ≥ 5 years after transplantation. Hepatic cysts were more prevelent in the A group (88.5 % versus 62.5 %, p = 0.032). Hypertension was the only postoperative complication significantly more prevelent in the B group (95.8 % versus 69.2 %, p = 0.014).
The ultrasonography of non-nephrectomized polycystic kidneys: the average reduction in length and width after transplantation was statistically significant for all recipients (length – 20.0 ± 35.8 mm, p = 0.026; width – 16.8 ± 22.9 mm, p = 0.001). The significant reduction in kidney width after transplantation was observed separately in both groups (40.2 ± 27.3 mm, p = 0.03 and 11.0 ± 18.1 mm, p = 0.014), however more noticeable reduction was evident in the A group (p = 0.041). Kidney graft and recipient overall survival were similar in both groups (A group vs B group: kidney graft survival 4.0 ± 3.6 vs
4.4 ± 3.0 years, p = 0.544; recipients overall survival – 4.6 ± 3.7 vs 5.6 ± 2.7 years, p = 0.592 respectively).
Conclusion. We observed no significant difference in postoperative outcomes between groups, yet hypertension was more prevelent in the B group. Significant decrease in polycystic kidney size after kidney transplantation was observed. We found no benefit after nephrectomy in graft or overall recipient survival.
January 15, 2015 Accepted:
February 26, 2015