J Korean Soc Transplant.  2016 Mar;30(1):24-30. 10.4285/jkstn.2016.30.1.24.

Effect of Simultaneous Nephrectomy on Perioperative Blood Pressure and Graft Outcome in Renal Transplant Recipients with Autosomal Dominant Polycystic Kidney Disease

• Jo HA
• Park HC
• Kim H
• Han M
• Jeong JC
• Oh KH
• Yang J
• Jeon HJ
• Koo TY
• Ha J
• Kwak C
• Hwang YH
• Ahn C

• KMID: 2202624
• DOI: http://doi.org/10.4285/jkstn.2016.30.1.24

Abstract

BACKGROUND
For various reasons, kidney transplant recipients with autosomal dominant polycystic kidney disease (ADPKD) often undergo native nephrectomy in preparation for the transplantation. Simultaneous nephrectomy can result in hypotensive events perioperatively and affect transplant outcome adversely. Our aim was to evaluate the effect of simultaneous native nephrectomy (SNx) on perioperative blood pressure and graft outcome compared to non-nephrectomy (NNx) in renal transplant recipients with ADPKD.
METHODS
Data regarding renal function and blood pressure were collected from 42 renal transplant recipients with ADPKD. The primary outcome was graft function over 1 year post-transplant. The secondary outcomes were patient and graft survival, postoperative hypotensive events, and blood pressure control. We compared units of anti-hypertensive medication used by transplanted ADPKD patients in the SNx and NNx groups.
RESULTS
Patients with SNx during kidney transplantation showed similar rates of patient and graft survival and renal function. Although they had significantly more hypotensive events during the perioperative period (69.2% vs. 37.5% in NNx, P=0.045), no harmful influence on renal function was observed. No difference in mean blood pressure during the 1-year post-transplant period was observed between the two groups; however, the SNx group required fewer units of anti-hypertensive medication.
CONCLUSIONS
SNx is a relatively safe procedure. Graft outcome in the SNx group was not inferior to that of the NNx group, and patients with SNx can have well-controlled blood pressure.

Keyword

Autosomal dominant polycystic kidney; Nephrectomy; Kidney transplantation

MeSH Terms

Blood Pressure*
Graft Survival
Humans
Kidney
Kidney Transplantation
Nephrectomy*
Perioperative Period
Polycystic Kidney, Autosomal Dominant*
Transplantation*
Transplants*

Figure

• 

  Fig. 1. Kaplan-Meier curves for (A) patient survival and (B) graft survival between non-nephrectomy (NNx, n=16) and simultaneous native nephrectomy (SNx, n=26) groups. P-value is estimated by log-rank test.

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  Fig. 2. (A) Mean blood pressure (BP; mmHg, mean±SD [total no.]) and (B) units of antihypertensive medication during follow-up period after nephrectomy. Abbreviations: NNx, non-nephrectomy; SNx, simultaneous native nephrectomy. aP＜0.05.

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