The Role of Native Nephrectomy in Autosomal Dominant Polycystic Kidney Disease Transplant Candidates

Autosomal dominant polycystic kidney disease (ADPKD) is a genetic condition characterized by the development of multiple cysts in the kidneys, liver, and pancreas. In the United States, the mean age of presentation for ADPKD is between the 3rd and 5th decades, and approximately 50% of patients will develop ESRD by age 60, making ADPKD responsible for 7-10% of the ESRD population. The objective of this review was to assess the current literature for determining optimal timing of native nephrectomy in relation to renal transplantation for ADPKD. Regardless of timing, native nephrectomy in ADPKD patients should be avoided without clear indications due to risks, morbidity and mortality. Indications for nephrectomy may include appropriately selected patients with severe pain, recurrent infections, chronic hematuria, and symptoms of mass effect. These indications and type of graft planned can guide the ideal nephrectomy timing. Nephrectomies prior to transplantation may prevent subsequent UTIs and post-transplant infection. Simultaneous nephrectomy with kidney transplantation may be performed safely without significant graft or patient compromise in carefully selected candidates. Nephrectomy performed posttransplantation should be avoided and usually is only indicated in the emergent setting. Future studies involving larger sample sizes and with long-term graft and patient survival data are needed to further define and evaluate nephrectomies in ADPKD transplant patients.