KHA-CARI Autosomal Dominant Polycystic Kidney Disease Guideline: Management of End-Stage Kidney Disease.

those that are being considered as potential kidney donors, need to be carefully screened and excluded from having ADPKD (KHA-CARI ADPKD Guidelines: Genetics, Imaging, and Screening subtopics), prior to living donor transplantation. Nephrectomy of a polycystic kidney prior to the time of transplantation may be required due to insufficient intra-abdominal space for the new allograft. Nephrectomy at the time of transplantation may be technically challenging for both procedures via a single incision. We acknowledge that these technical challenges may mean that pre-emptive native nephrectomy is preferred over simultaneous native nephrectomy. The need for nephrectomy requires clinical judgment by the transplant surgeon correlated with imaging studies (computed tomography scan, magnetic resonance imaging, or ultrasound) in consultation with the nephrologist. Polycystic nephrectomy should be performed by the laparoscopic technique where possible due to less morbidity compared to an open approach. We suggest patients with ADPKD nearing endstage kidney disease receive predialysis education as for any other patient with chronic kidney disease (refer to KHA-CARI Acceptance Onto Dialysis, subtopic Predialysis Education).