Vascular Surgery and Organ Transplant Unit, Azienda Ospedaliera Policlinico of Catania, Catania, Italy.
Department of Medical Biopathology and Biotechnologies, University of Palermo, Palermo, Italy.
PLoS One. 2018 Dec 27;13(12):e0209332. doi: 10.1371/journal.pone.0209332. eCollection 2018.
The indication to bilateral nephrectomy in patients with autosomal dominant polycystic kidney scheduled for kidney transplantation is controversial. Indeed, the progressive enlargement of cysts may increase the risk of complications and the need for nephrectomy. However, very few studies investigated the change in kidney volume after kidney transplantation.
In this prospective cohort study, the change in native kidney volume in polycystic patients was evaluated with magnetic resonance imaging. Forty patients were included in the study. Kidney diameters and total kidney volume were evaluated with magnetic resonance imaging in patients who underwent simultaneous nephrectomy and kidney transplantation and in patients with kidney transplant alone, before transplantation and 1 year after transplantation.
There was a significant reduction of kidney volume after transplantation, with a mean degree of kidney diameters reduction varying from 12.24% to 14.43%. Mean total kidney volume of the 55 kidney considered in the analysis significantly reduced from 1617.94 ± 833.42 ml to 1381.42 ± 1005.73 ml (P<0.05), with a mean rate of 16.44% of volume decrease. More than 80% of patients had a volume reduction in both groups.
Polycystic kidneys volume significantly reduces after kidney transplantation, and this would reduce the need for prophylactic bilateral nephrectomy in asymptomatic patients.
对于接受肾移植的常染色体显性多囊肾病患者，是否行双侧肾切除术存在争议。的确，囊肿的进行性增大可能会增加并发症的风险和需要肾切除术的风险。然而，很少有研究调查肾移植后肾脏体积的变化。
在这项前瞻性队列研究中，通过磁共振成像评估多囊肾病患者的原生肾脏体积变化。共纳入 40 例患者。对同时行肾切除术和肾移植术的患者以及仅行肾移植术的患者，在移植前和移植后 1 年，通过磁共振成像评估肾脏直径和总肾脏体积。
移植后肾脏体积明显减少，肾脏直径的平均缩小程度从 12.24%到 14.43%不等。分析中考虑的 55 个肾脏的总肾脏体积从 1617.94±833.42ml 显著减少至 1381.42±1005.73ml（P<0.05），平均体积减少率为 16.44%。两组中均有超过 80%的患者肾脏体积减少。
肾移植后多囊肾体积明显缩小，这将减少无症状患者预防性双侧肾切除术的需求。
