Perioperative Outcomes of Nephrectomy for Autosomal Dominant Polycystic Kidney Disease

Patients with autosomal dominant polycystic kidney disease (ADPKD) frequently require nephrectomy before renal transplant or for clinical symptoms. We encountered no population-based data on perioperative outcomes for nephrectomy in patients with ADPKD, indicating a knowledge gap for patient counseling and quality benchmarking.

We analyzed the American College of Surgeons National Surgical Quality Improvement Program database (2015-2022) to identify patients undergoing nephrectomy with a diagnosis of ADPKD. The primary outcome was major complications. Multivariable logistic regression was used to identify predictors of outcomes.

The cohort comprised 823 patients with a median age of 54 years (range 19-87). Preoperative hypertension (79.3%), dialysis (49.2%), and steroid use (44.8%) were common. Major complications occurred in 7.0% of patients. Minimally invasive surgery was associated with lower major complication risk (odds ratio 0.269; P < .001), reduced length of stay (3 vs 6 days), and decreased transfusion rates (7.8% vs 29.1%). Preoperative steroid use was also associated with reduced risk. Dialysis status and bilateral nephrectomy were not significant predictors. Thirty-day mortality was noted in 4 patients (0.5%).

Major complications and death are rare after nephrectomy for ADPKD despite the high rate of dialysis and renal transplantation in this population. When technically feasible, minimally invasive surgery may be beneficial in nephrectomy for ADPKD.