Nephrectomy Strategies and Kidney Transplantation in Polycystic Kidney Disease

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited cause of end-stage renal failure, characterised by progressive cyst formation that distorts renal architecture and increases organ volume. Clinical manifestations include pain, haematuria, recurrent infections and hypertension, often necessitating nephrectomy to alleviate compressive symptoms or create space for graft placement. Nephrectomy strategies encompass pre-transplant, simultaneous and post-transplant approaches, each balancing surgical risk, residual renal function and immunological considerations. Open surgery remains the traditional standard, but minimally invasive techniques—laparoscopic and robotic—have gained traction for their reduced blood loss, shorter hospital stay and faster recovery. Timing of nephrectomy influences perioperative morbidity, dialysis duration and transplant logistics, while kidney volume often decreases after successful transplantation, potentially obviating prophylactic bilateral nephrectomy in asymptomatic individuals. Optimising the decision-making process in ADPKD requires integration of surgical advances, quality-of-life outcomes and long-term graft function to tailor interventions to patient symptoms, anatomical challenges and resource availability globally.

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Nephrectomy Strategies and Kidney Transplantation in Polycystic Kidney Disease publication trend

The graph below shows the total number of articles in nephrectomy strategies and kidney transplantation in polycystic kidney disease across all publications each year (not limited to Nature Index journals).

Technical terms

Autosomal dominant polycystic kidney disease (ADPKD): inherited disorder characterised by progressive cyst formation in both kidneys, leading to enlargement, loss of function and systemic complications.

Native nephrectomy: surgical removal of one or both of a patient’s original kidneys, undertaken to alleviate symptoms, manage complications or enable transplantation.

Simultaneous nephrectomy: procedure in which native nephrectomy is performed at the same session as kidney transplantation to reduce the number of surgeries.

Laparoscopic nephrectomy: minimally invasive removal of a kidney via small abdominal incisions using a camera and specialised instruments, associated with reduced pain and shortened hospital stay.

Robotic nephrectomy: advanced minimally invasive technique employing robotic systems for enhanced precision, dexterity and three-dimensional vision during kidney removal in complex cases.

References

1. Simultaneous Native Nephrectomy and Kidney Transplantation in Patients With Autosomal Dominant Polycystic Kidney Disease. PLOS ONE (2016).
2. Laparoscopic Nephrectomy versus Open Nephrectomy for Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Meta-Analysis. PLOS ONE (2015).
3. Native Nephrectomy before and after Renal Transplantation in Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD). Journal of Clinical Medicine (2019).
4. Change in kidney volume after kidney transplantation in patients with autosomal polycystic kidney disease. PLOS ONE (2018).
5. Robotic bilateral nephrectomy for large polycystic kidney disease. BJUI Compass (2023).
6. The impact of pre-transplantation nephrectomy on quality of life in patients with autosomal dominant polycystic kidney disease. World Journal of Urology (2023).
7. Native nephrectomy in polycystic kidney disease patients on transplant lists: how and when?. Journal of Nephrology (2024).