Simultaneous native nephrectomy with renal transplantation: Our experience and a brief literature review

Abstract

Objective: There is a need for native kidney nephrectomy to increase renal transplant surgery’s safety or improve postoperative function in some cases. The timing of the procedure is still controversial. This study aimed to present our native nephrectomy procedures performed simultaneously with the transplantation in light of the literature.
Material and Methods: A retrospective analysis was performed on the data of 245 patients who underwent renal transplantation due to end-stage renal failure (ESRD) between September 2011 and February 2020. Patients who underwent unilateral or bilateral nephrectomy simultaneously with transplantation were included. Demographic characteristics of the patients, preoperative and postoperative laboratory data, primary disease, presence of comorbid diseases, duration of dialysis, duration of vascular anastomosis, surgical and clinical complications, duration of hospital stay, and graft functions were recorded. 
Results: 12 patients underwent ipsilateral or bilateral native nephrectomy simultaneously with renal transplantation. The primary diseases of the patients leading to ESRD were as follows; 6 (50%) patients with Polycystic Kidney Disease (PKD), 5 (41.6%) patients with vesicoureteral reflux (VUR), one (8.3%) patient with kidney stones. Postoperative fever in three patients, erythrocyte replacement therapy in three patients, urosepsis and urinary drainage catheter requirement in one patient due to lymphocele was recorded. Two patients developed humoral rejection, and two patients developed BK virus nephropathy.
Conclusion: In the presence of appropriate indications, simultaneous native nephrectomy is a safe and effective method in patients preparing for renal transplantation. In centers with sufficient experience and equipment, it may be preferable to perform native nephrectomy simultaneously with renal transplantation.

Keywords

• Kidney transplantation
• Nephrectomy
• Bilateral nephrectomy
• polycystic kidney disease
• complications

Renal transplantasyonla eş zamanlı nativ nefrektomi: Deneyimlerimiz ve kısa bir literatür derlemesi

Abstract

Amaç: Renal transplant cerrahisinin güvenliğini arttırmak veya postoperatif fonksiyonları iyileştirmek adına, bazı durumlarda nativ böbrek nefrektomisi gereksinimi söz konusu olmaktadır. Prosedürün ise zamanlaması halen tartışmalıdır. Bu yazımızda, transplant ile eş zamanlı gerçekleştirdiğimiz nativ nefrektomi prosedürlerimizi literatür eşliğinde sunmayı amaçladık.
Gereç ve Yöntemler: Eylül 2011 ve Şubat 2020 tarihleri arasında Son Dönem Böbrek Yetmezliği (SDBY) nedeniyle renal transplantasyon gerçekleştirilen 245 hastanın verileri retrospektif olarak incelendi. Transplantasyon ile eşzamanlı tek taraflı veya bilateral nefrektomi gerçekleştirilen hastalar dahil edildi. Hastaların demografik özellikleri, preoperatif ve postoperatif laboratuar verileri, primer hastalığı, komorbid hastalık varlığı, diyaliz süreleri, vasküler anastomoz süreleri, cerrahi ve klinik komplikasyonları, hastaneye yatış süreleri ve greft fonksiyonları kaydedildi. 
Bulgular: Renal transplantasyona eş zamanlı ipsilateral veya bilateral nativ nefrektomi gerçekleştirilen toplam 12 hasta mevcuttu. Hastaların SDBY’ye yol açan primer hastalıkları şu şekildeydi; 6 (50%) hasta Polikistik Böbrek Hastalığı (PBH), 5 (41,6%) hasta vezikoüretral reflü (VUR), bir (8,3%) hasta ise böbrek taşı. Üç hastada postoperatif ateş, üç hastada eritrosit replasman tedavisi, bir hastada ürosepsis ve lenfosel nedenli perkutan drenaj kateteri gereksinimi kaydedildi. İki hastada hümoral rejeksiyon ve iki hastada BK virüs nefropatisi gelişti.
Sonuç: Uygun endikasyon varlığında renal transplantasyon hazırlığındaki hastalarda eş zamanlı nativ nefrektomi güvenli ve efektif bir yöntemdir. Yeterli deneyim ve donanımı olan merkezlerde, nativ nefrektominin renal transplantasyon ile eş zamanlı gerçekleştirilmesi tercih edilebilir.

Keywords

• Böbrek nakli
• nefrektomi
• bilateral nefrektomi
• polikistik böbrek hastalığı
• komplikasyonlar

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