Patients with autosomal dominant polycystic kidney disease (ADPKD) who undergo renal transplantation have significantly better graft survival than renal transplant recipients without ADPKD, a French study found. ADPKD patients, however, may suffer from more thromboembolic events.
Antoine Jacquet, MD, of the Nephrology and Renal Transplantation Department at Bicetre Hospital in Paris, and his colleagues conducted what they call the largest longitudinal study to date on renal transplant in patients with ADPKD. The investigators compared the outcomes following renal transplantation of 534 ADPKD patients with 4,779 non-ADPKD renal transplant patients.
The researchers, who published their findings online in Transplant International, noted that previous studies suggested that renal transplantation in ADPKD patients was associated with an increased risk of new-onset diabetes, adverse cardiovascular events, sepsis, or various surgical complications. However, previous studies have been limited in their size and by their short number of years of follow-up, they observed.
Dr. Jacquet and his team found that ADPKD patients were transplanted with significantly older kidneys than non-ADPKD patients (44.1 vs. 41.1 years) and with kidneys that came from more patients who died from cardiovascular-related complications (43% vs. 37%). ADPKD patients were older (52.8 vs. 44.3 years) and more frequently female (45% vs. 37%). In addition, ADPKD patients were transplanted with a smaller proportion of living donors and more prolongated cold ischemia times.
The finding that ADPKD patients had significantly higher graft survival rates at 15 years (76% vs. 66%) was unexpected, the researchers reported. It was unclear why thromboembolic complications were significantly more frequent in ADPKD patients, as this had not been previously reported, they added.
The investigators found that ADPKD patients had more metabolic complications and increased rates of hypertension, but the prevalence of bacterial infections was not increased.
The study provides important new insights that may lead to improved care in this kidney transplant population.