Do Patients with Autosomal Dominant Polycystic Kidney Disease Need Native Nephrectomy before Kidney Transplantation? A Single-Center Retrospective Study over 11 Years.

Introduction: The aim of the study was to explore whether patients with autosomal dominant polycystic kidney disease (ADPKD) require native nephrectomy prior to kidney transplantation.

Methods: A retrospective analysis of 44 ADPKD patients who received deceased donor allogeneic kidney transplantation at Beijing Friendship Hospital (2013-2024) was conducted. Patients were divided into pre-transplantation nephrectomy (PN) group (n = 29) and a non-PN (nPN) group (n = 15). The pre-transplant general status, surgical duration, intraoperative blood loss, postoperative recovery, and survival rates were compared between the two groups. Additionally, total kidney volume (TKV) and adjusted TKV were used to predict ultimate nephrectomy (UN) status via a receiver operating characteristic (ROC) curve analysis. Finally, the nPN group was subdivided to UN group (n = 8) and non-ultimate nephrectomy (nUN) group (n = 7) based on final nephrectomy status, with comparisons made regarding kidney function and survival analysis.

Results: The nPN group had better long-term survival (62 vs. 38 months, p < 0.001). ROC analysis showed BSA-TKV had the highest predictive accuracy (sensitivity: 69.44%, specificity: 87.50%). Subgroup analysis indicated post-transplant nephrectomy did not impact long-term survival or kidney function.

Conclusion: Pre-transplant nephrectomy in ADPKD patients should be limited to essential cases as it may prolong recovery and reduce survival. Post-transplant nephrectomy is a safer alternative, guided by predictive metrics like BSA-TKV.