Transplantation for polycystic kidney disease

Area of Science:

• Nephrology
• Transplantation Immunology

Background:

• Polycystic kidney disease (PKD) is a common genetic disorder.
• Renal transplantation is a treatment option for end-stage renal disease in PKD patients.

Purpose of the Study:

• To compare outcomes of renal allografts in patients with and without PKD.
• To evaluate the impact of pretransplant procedures and immunosuppression on graft survival and patient mortality in PKD recipients.

Main Methods:

• Retrospective analysis of 108 PKD and 2440 non-PKD patients receiving cadaver renal allografts.
• Comparison of recipient characteristics, pretransplant interventions, and post-transplant outcomes.
• Analysis of HLA matching, transfusion effects, and immunosuppressive therapy (antilymphocyte serum).

Main Results:

• No significant difference in overall graft or patient survival between PKD and non-PKD groups.
• PKD patients had higher mortality from bacterial sepsis, particularly gram-positive organisms.
• Pretransplant transfusions improved graft survival in both groups.
• Antilymphocyte serum (ALS) did not improve graft survival in PKD patients and correlated with increased mortality.
• Bilateral native nephrectomy was associated with increased post-graft failure anemia and death.

Conclusions:

• Pretransplant bilateral native nephrectomy and posttransplant ALS should be used cautiously in polycystic kidney disease patients due to potential increased morbidity and mortality.
• Careful patient selection and management are crucial for optimizing renal transplant outcomes in PKD.