Transplant Plus Native Nephrectomy May Benefit Polycystic Kidney Disease (ADPKD) Patients
Approach resulted in improved hypertension control in those with ADPKD.
Native unilateral nephrectomies in conjunction with renal transplantation in patients with autosomal dominant polycystic kidney disease (ADPKD) can improve control of hypertension, according to study findings presented at the 32nd World Congress of Endourology in Taipei, Taiwan.
A team at Indiana University School of Medicine in Indianapolis led by Chandru P. Sundaram, MD, retrospectively examined hypertension control in 143 ADPKD patients who underwent renal transplantation from 2003 to 2013. William Goggins, MD, performed the transplantation and the concurrent nephrectomies. Dr. Sundaram performed the laparoscopic contralateral native nephrectomies.
Of the 143 patients, 67 underwent transplantation alone and 76 underwent transplantation with concurrent unilateral native nephrectomy. The nephrectomy group included 40 who had a native kidney removed at the time of transplantation and 36 who had a staged contralateral native nephrectomy. The staged nephrectomies were completed in a median of 9.8 months post-transplantation via a laparoscopic approach.
Comparing preoperative to postoperative antihypertensive medication use, patients who underwent native concurrent unilateral nephrectomy had a significantly greater decrease in the mean number of medications at 12, 24, and 36 months follow-up than those who underwent transplantation alone (-1.2 vs. -0.5, 1.1 vs. 0.3, and -1.2 vs. 0.4, respectively).
The nephrectomy patients also experienced significantly greater decreases in defined daily dose (DDD) of antihypertensive drugs at 12, 24, and 36 months (-3.3 vs. -1.0, -2.9 vs. -1.0, and -2.7 vs. 0.6, respectively). Greater hypertension control was achieved in patients undergoing staged completion native nephrectomies.
DDD is a means of standardizing and analyzing drug consumption among patients, the authors explained. It is the assumed average maintenance dose per day for a medication used for its main indication in adults.
Clinton Bahler, MD, from Dr. Sundaram's team, presented the poster, which was awarded the Olympus prize for the best presentation under the clinical research category.