AUA 2011 - The management of polycystic kidneys in renal transplantation concomitant or staged nephrectomy - Session Highlights

WASHINGTON, DC USA ( - Polycystic kidney (PK) disease occurs in a ratio of 1:1000. It can cause complications such as hypertension (60%), nephrolithiasis (20-30%), cyst-related bleeding, and infection. Nearly 50% will develop ESRD by age 60. Patients with PK disease account for 6-7% of those waiting for kidney transplants (1999-2008). Dr. Michael Phelan made the case for simultaneous bilateral removal of large PKs at the time of transplantation. He felt that this would provide symptomatic relief form pain, recurrent cyst infections and bleeding and create space in renal allograft. This prevents the need for 2 anesthesias. Removal of the PKs post transplant can lead to wound issues (complication rates 20-50%) , possible injury to the transplant, and intraoperative hypotensive issues. He felt that the convenience of the one surgery is best for the patient.


At the University of Maryland, simultaneous removal of PK and transplanting a new kidney is performed using 3 surgical teams (a laparoscopic surgeon performs donor nephrectomy, urologist removes PK and a transplant surgeon implants new kidney. Dr. Patrick Luke countered with a convincing argument that nephrectomy of PKs and transplantation of a new kidney does not always belong together but should be done as staged procedures. He noted that significant blood loss is the operative challenge when doing these 2 procedures together. While staged procedures have been the standard and are feasible, there is no evidence that it is a superior method. Doing the 2 procedures at the same time can lead to higher transfusion rate and graft torsion risk. He concluded that simultaneous approach may be preferable in “straightforward" cases but sequential approach should be done in predictably difficult cases.

Panelists: Michael Phelan (concomitant) and Patrick Luke (Staged)


Moderated by Vankatesh Krishnamurthi at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA

Reported for UroToday by Diane K. Newman, RNC, MSN, CRNP, FAAN and Continence Nurse Practitioner Specialist - University of Pennsylvania Medical Center.



The opinions expressed in this article are those of the Contributing Editor and do not necessarily reflect the viewpoints of the American Urological Association.



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