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Minerva Urology and Nephrology 2022 Sep 12

DOI: 10.23736/S2724-6051.22.04972-2


language: English

Native nephrectomy and arterial embolization of native kidney in autosomal dominant polycystic kidney disease patients: indications, timing and postoperative outcomes. A systematic review

Thomas PRUDHOMME 1 , Romain BOISSIER 2, Vital HEVIA 3, Riccardo CAMPI 4, Alessio PECORARO 4, Alberto BREDA 5, Angelo TERRITO 5, for the EAU - Young Academic Urologist (YAU) group of Kidney Transplant

1 Department of Urology, Rangueil University Hospital, Toulouse, France; 2 Department of Urology, La Conception University Hospital, Marseille, France; 3 Department of Urology, University Hospital Ramón y Cajal, Madrid, Spain; 4 Department of Urology, Florence University Hospital, Florence, Italy; 5 Oncology and Renal Transplant units, Puigvert’s Foundation, Barcelona, Spain


INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common causes of a need of renal replacement therapy. The need (elective vs. systematic) and timing of native kidney nephrectomy (before, after or during kidney transplantation) is a matter of debate and alternatives to surgery, mainly transcatheter arterial embolization have been explored. We performed a systematic review to report all available evidence on postintervention outcomes of native nephrectomy and arterial embolization in ADPKD patients.
EVIDENCE ACQUISITION: A search on Medline, Embase, and Cochrane databases was performed to identify all studies reporting outcomes of native nephrectomy or arterial embolization in APKDs.
EVIDENCE SYNTHESIS: Concerning native nephrectomy, a total of 3,626 patients in 37 studies were included with 735, 210 and 2,681 patients who underwent native nephrectomy respectively before, after or during kidney transplantation. Major complications were 12.2% in unilateral nephrectomy before transplantation, 25.0% in bilateral nephrectomy before transplantation, 17.7% in unilateral nephrectomy during transplantation, 20.8% in bilateral nephrectomy during transplantation and 23.8% in unilateral and bilateral nephrectomy after transplantation. A total of 230 patients in 7 series of arterial embolization were included. All arterial embolization were performed before transplantation. Mean volume reduction ranged from 36.3% at 3 months to 49% at 6 months. The major post-intervention complication rate was 1%.
CONCLUSIONS: Unilateral native nephrectomy before kidney transplantation was associated with the lowest major postoperative complication rate and appears to be the preferred strategy. Arterial embolization reduces kidney volume by 49% at 6 months. Arterial embolization could be considered when the reduction in size of the native kidney is not urgent.

KEY WORDS: ADPKD; Autosomal dominant polycystic kidney disease; Native nephrectomy; Arterial embolization; Kidney allograft

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