Navratil Pavel, Chalupnik Jiri, Merkl Tomas, Spacek Jiri, Matyskova Kubisova Michaela, Safranek Roman, Novak Ivo, Pacovsky Jaroslav, Navratil Pavel, Gunka Igor
Department of Urology, University Hospital Hradec Kralove, Sokolska 581, 500 05, Hradec Králové, Czech Republic.
Charles University, Faculty of Medicine in Hradec Kralove, Hradec Králové, Czech Republic.
Int Urol Nephrol. 2025 Feb;57(2):391-398. doi: 10.1007/s11255-024-04234-y. Epub 2024 Oct 14.
Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder that frequently leads to end-stage renal disease. In this study, we examine the indications, procedures, and outcomes of native nephrectomy (NN) in ADPKD patients at our transplant center. Drawing on 25 years of clinical practice, we aim to provide insights into the surgical management of ADPKD, focusing on the specific factors influencing NN.
A retrospective study was conducted involving ADPKD patients who underwent KT and NN between 1999 and 2023. Collected data encompassed demographics and surgery parameters, such as duration, hospital stay length, blood loss, and complications. Patients were classified based on the urgency (acute/planned) of the NN and its type (unilateral/bilateral), followed by an analysis of the outcomes per group.
Out of 152 patients post-KT for ADPKD, 89 (58.6%) underwent NN. The procedures were predominantly unilateral (71; 64%), with bilateral NN accounting for 40 (36%) cases. NN timing relative to KT was 31 (27.9%) pretransplant, 9 (8.1%) concomitant, 51 (45.9%) posttransplant, and 10 (9%) patients undergoing the sandwich technique. Acute NN were performed in 42 cases, while 69 were planned. Acute NNs were associated with longer surgeries, greater blood loss, and a higher incidence of perioperative complications compared to planned NNs. Specifically, unilateral acute NN had a 23.8% complication rate compared to 2.9% in planned cases; bilateral acute NN showed a 28.6% complication rate versus 4.3% in planned cases.
This investigation accentuates the significance of planning and selection in NN for ADPKD, factoring in the heightened risk of complications. Acute NN are linked to worse outcomes, including higher rates of complications. The data emphasize the necessity of tailored surgical approaches based on individual patient circumstances.
常染色体显性多囊肾病（ADPKD）是一种常见的遗传性疾病，常导致终末期肾病。在本研究中，我们考察了我院移植中心ADPKD患者接受自体肾切除术（NN）的适应症、手术过程及结果。基于25年的临床实践，我们旨在深入了解ADPKD的外科治疗，重点关注影响NN的具体因素。
对1999年至2023年间接受肾移植（KT）和NN的ADPKD患者进行回顾性研究。收集的数据包括人口统计学和手术参数，如手术时长、住院时间、失血量及并发症。根据NN的紧急程度（急性/计划性）及其类型（单侧/双侧）对患者进行分类，然后分析每组的结果。
在152例接受ADPKD肾移植的患者中，89例（58.6%）接受了NN。手术主要为单侧（71例；64%），双侧NN占40例（36%）。NN相对于KT的时间为移植前31例（27.9%）、同期9例（8.1%）、移植后51例（45.9%），10例（9%）患者采用三明治技术。42例进行了急性NN，69例为计划性手术。与计划性NN相比，急性NN手术时间更长、失血量更大、围手术期并发症发生率更高。具体而言，单侧急性NN的并发症发生率为23.8%，而计划性手术为2.9%；双侧急性NN的并发症发生率为28.6%，计划性手术为4.3%。
本研究强调了ADPKD患者NN手术规划和选择的重要性，要考虑到并发症风险增加的因素。急性NN与更差的结果相关，包括更高的并发症发生率。数据强调了根据患者个体情况制定个性化手术方案的必要性。
