Staged vs. simultaneous bilateral nephrectomy and kidney transplantation in patients with autosomal dominant polycystic kidney disease
Outcomes and cost
Keywords:Kidney transplantation, polycystic kidney, autosomal dominant, nephrectomy
Introduction: We sought to compare cost and safety outcomes of patients who received a kidney transplant and bilateral nephrectomy in either a simultaneous or staged approach.
Methods: We reviewed all adult patients with autosomal dominant polycystic kidney disease (ADPKD) who received a kidney transplant and underwent bilateral nephrectomy between 2008 and 2019. Patients were divided into two groups: staged (nephrectomy prior to transplant) and simultaneous (nephrectomy at the time of transplant). The primary outcome was cumulative cost of nephrectomy and transplantation ($CAD). We analyzed several secondary outcomes, including 90-day Clavien-Dindo complication rates.
Results: A total of 114 patients with ADPKD received a kidney transplant over 11 years. Of these, 28 patients underwent both nephrectomy and transplantation (10 staged, 18 simultaneous). More patients in the simultaneous group had a living donor transplant (83% vs. 0%, p<0.001). Creatinine clearance at one year/ last followup did not differ between groups (p=0.12). With similar overall complication rates between groups, the transfusion rate was also similar between groups (simultaneous 50% vs. staged 40%, p=0.91). Total cost was lower in the simultaneous group ($23 775.33 CAD vs. $35 048.83 CAD, p<0.001), largely owing to a longer total length of stay in the staged group as compared to the simultaneous group (8.1 vs. 14.5 days, p<0.001).
Conclusions: These data suggest that a simultaneous approach to bilateral nephrectomy and kidney transplantation provides potential cost savings with no adverse outcomes. This provides a rationale to investigate simultaneous nephrectomy and transplantation in the deceased donor setting.
How to Cite
You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:
- Post the Article on any Web site
- Translate or authorize a translation of the Article
- Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
- Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.
The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.
You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.
The CUA also requires you to warrant the following:
- That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
- That all individuals who have made a substantive contribution to the article are acknowledged;
- That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
- That the Article does not libel or violate the privacy rights of any third party.