Autosomal Dominant Polycystic Kidney Disease Patients Requiring Nephrectomy: Characteristics and Surgical Considerations.

Background: Nephrectomies are major surgeries often required in ADPKD for symptom control, removal of septic/malignant foci, and to create space for renal transplantation. Whether ADPKD patients should proceed with nephrectomy/ies should be guided by patient characteristics, technical considerations and anticipated risks and benefits.

Methods: A retrospective review of prospectively collected data for all patients who underwent nephrectomy/ies between 1 January 1995 and 31 December 2021, comparing ADPKD patients to patients with alternative primary nephrological conditions. Patient characteristics, technical aspects, and outcomes informing the risks and benefits of nephrectomies were examined. Statistical analyses included descriptive statistics, χ²/Fisher's exact test and independent samples Mann-Whitney U test, as appropriate.

Results: At the time of first nephrectomy, ADPKD patients were older and more likely to have end-stage renal failure, hypertension, gastro-oesophageal reflux disease, and hernia compared to non-ADPKD patients. They were more likely to require bilateral nephrectomies, open nephrectomies, and, where transplanted, receive donation after circulatory death. They were at higher risk of post-operative hypotension, anaemia, and more likely to require blood transfusions. Otherwise, nephrectomies achieved their indications in our ADPKD cohort with no apparent increase in adverse events. Renal cell carcinoma appears to be of higher incidence in our cohort, with a high proportion of multifocality and bilaterality, advanced staging at diagnosis and incidental diagnoses on histopathology.

Conclusion: Overall, in our ADPKD patients who received nephrectomy/ies, the procedure appeared to be safe and effective, with benefits outweighing risks. RCC exclusion is a prudent consideration especially for ADPKD patients on dialysis awaiting transplantation.