Weekly issue 2026-W39 ·
Nephrectomy in Kidney Transplant Candidates With Autosomal Dominant Polycystic Kidney Disease
Plain language
Before or after a kidney transplant, some people with ADPKD have one or both of their own kidneys removed. At one transplant centre, 79 of 109 people with ADPKD had this surgery, most often before the transplant and on both sides, mainly to make room for the new kidney; infection, pain and bleeding cysts were other reasons. Removing both kidneys before transplant accounted for most surgical complications. Whether, when and which side should be decided case by case.
Clinical note
Single-centre retrospective series, 109 ADPKD transplant recipients (1999–2021); 72% underwent native nephrectomy, mostly pre-transplant and bilateral. Nephrectomy group heavier and more often on dialysis pre-transplant. Indications: insufficient iliac fossa space, then cyst infection, chronic pain, haemorrhagic cysts. Complications (transfusion, collections, incisional hernia, reintervention) clustered in bilateral pre-transplant procedures, without significant between-strategy differences; no malignancy on histology. Supports individualised, anatomy- and symptom-based timing and laterality.
Question for your next visit
If I am heading towards a transplant, do my kidneys look large enough or troublesome enough that removing one or both might be needed, and when?