Introduction: To evaluate early outcomes in polycystic kidney disease (PKD) patients with limited space for a transplant undergoing simultaneous native nephrectomy and transplantation, compared with a staged nephrectomy approach.
Methods: This retrospective cohort study enrolled 516 PKD patients who underwent kidney transplants between 2017 and 2023. Patients were categorized into three groups based on their native nephrectomy status: pre-transplant nephrectomy (staged group, n=82), simultaneous nephrectomy and transplant (simultaneous group, n=44), and patients for whom the nephrectomy was not required (control group, n=390). The outcomes were death and graft loss within 3 months post-transplantation.
Results: The simultaneous group, compared with the staged group, had older patients (average 52.5 vs. 47.0 years, p<0.001), higher BMI (24.3 vs. 23.0 Kg/m2, p<0.001), and fewer previous blood transfusions (27.3% vs. 48.8%, p=0.001). A higher proportion of the simultaneous group received kidneys from deceased donors (86.4% vs. 68.3%, p=0.005). Surgical times were comparable between control and staged groups (115 and 117 minutes, respectively) but longer in the simultaneous group (180 minutes, p<0.001), with no significant effect on cold ischemia time (p=0.18). The need for vasoactive amines in the first 48 hours post-transplant was higher in the simultaneous group (38.6% vs. 12.3% in control and 14.6% in staged, p<0.001). However, ICU stay duration was similar across groups (p=0.26). Incidence (p=0.34) and duration (p=0.85) of delayed graft function in deceased donor recipients were comparable among all groups. Three-month graft loss rates were 4.7% in the simultaneous group, 6.3% in the staged group, and 3.6% in the control group (p=0.53). Corresponding mortality rates were 4.5%, 2.4%, and 4.1% (p=0.75).
Conclusion: Early outcomes for PKD patients undergoing simultaneous native nephrectomy and transplantation are comparable to those in staged nephrectomy and control groups, suggesting this approach is a viable alternative for patients with limited transplant space.