Nephrectomy in Kidney Transplant Candidates With Autosomal Dominant Polycystic Kidney Disease.

BACKGROUND: Native nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) undergoing kidney transplantation remains controversial, particularly regarding indications, timing, and laterality. This study evaluated surgical strategies and outcomes of native nephrectomy in ADPKD kidney transplant candidates. METHODS: We retrospectively analyzed adult patients with ADPKD who underwent kidney transplantation at a single center between 1999 and 2021. Demographic, transplant-related, nephrectomy-related, surgical, complication, and histopathological data were compared between patients who underwent native nephrectomy and those managed without nephrectomy. RESULTS: Among 109 patients with ADPKD, 79 (72%) underwent native nephrectomy and 30 (28%) did not. Patients undergoing nephrectomy had significantly higher body weight and were more frequently on dialysis before transplantation. Most nephrectomies were performed before transplantation, predominantly as bilateral procedures. The leading indication was lack of intra-abdominal space for graft implantation, followed by cyst infection, chronic pain, and hemorrhagic cysts. Post-transplant nephrectomy was uncommon and mainly performed for persistent or delayed native kidney-related complications. Postoperative complications, including bleeding requiring transfusion, fluid collections, incisional hernias, and surgical reinterventions, with no statistically significant differences in complication rates between nephrectomy strategies. No malignancy was identified in the available histopathological specimens. CONCLUSIONS: Native nephrectomy was frequently performed in ADPKD kidney transplant candidates, most often before transplantation and primarily to create sufficient space for graft implantation. Bilateral pre-transplant nephrectomy was the predominant strategy but was associated with most postoperative complications. These findings highlight the variability of current practice and support individualized, anatomy- and symptom-based decision-making.