Pre-transplant treatment of large polycystic kidney

摘要

AIM:To evaluate the indications,optimal timing and outcomes of native nephrectomy and other techniques in pretransplant treatment of autosomal dominant polycystic kidney disease(PKD).METHODS:A literature review was conducted using the PubMed and Epistemonikos databases.Keywords for pre-transplant surgical management of polycystic kidneys were:Transplant,treatment and PKD.Keywords for pre-treatment embolization of PKD were:Embolization,transplant and polycystic kidney disease.The inclusion criterions were all articles found using this search method.The exclusion criterions were articles found to include bias and not attending pre-transplant treatment options.Fifteen articles were included in our final analysis.Ten articles were found regarding embolization of PKD of which three reviews were selected for final analysis.The reviews were divided into pre transplant and intra transplant treatment for the surgical treatment of PKD.All articles meeting inclusion criteria were thoroughly analyzed by two independent reviewers.A third independent reviewer was consulted if the reviewers did not agree upon the inclusion or exclusion of a specific article.No statistical analysis was performed.RESULTS:Studies vary regarding the technique used(open or laparoscopic),laterality(single or bilateral)and temporality of nephrectomy with respect to renal transplant(pre-transplant or simultaneous to transplant).Several groups argue in favor of simultaneous nephrectomy and kidney transplant since it avoids the deleterious effects of being anefric.Long-term results and patient satisfaction are acceptable.However,it is associated with increased operative time,transfusion rate,morbidity and length of hospital stay.Based on small sample studies,bilateral nephrectomy prior to transplant has been associated with a higher risk of morbidity and mortality.Studies on laparoscopic approach report it as a feasible and safe alternative to the open surgery approach,highlighting its lower complication rate,transfusions and shorter hospital stay.Arterial embolization of the kidney appears as an effective and low morbid alternative for the management of large native kidneys.The reduction in renal size allow transplant in a significant number of patients,which makes it an appealing alternative to surgery.CONCLUSION:There is limited evidence regarding best pretrasnplant treatment of large PKD but to date embolization seems an appealing alternative to augment space for renal graft allocation.