Renal Transplantation and Polycystic: Surgical Considerations

Background: The indication and timing of nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) remain controversial, especially in patients who are candidates to renal transplantation (RT). The main surgical options such as unilateral vs. bilateral nephrectomy, nephrectomy before vs. after RT, or simultaneous nephrectomy and transplantation, are herein discussed. Objective: Evidence acquisition of the best surgical management available for ADPKD in the context of kidney transplantation. Acquisition of evidence: Systematic literature review in PubMed from 1978 to 2013 was conducted. Articles selected included: randomized controlled trials and cohort studies. Furthermore, well designed ADPKD reviews were considered for this study. Synthesis of evidence: Laparoscopic nephrectomy in ADPKD is a safe procedure with an acceptable complication rate. Unilateral nephrectomy has advantages over the bilateral one regarding the perioperative complication rate. Although the timing of nephrectomy is controversial, it seems that simultaneous nephrectomy and renal transplantation neither increase surgical morbidity nor affect graft survival. Conclusions: Simultaneous nephrectomy and RT appear to be an acceptable alternative to conventional two-stage procedure without any increased morbidity, in the context of ADPKD. Furthermore, laparoscopic nephrectomy performed in experienced centers is a safe alternative to conventional approach