The impact of pre-transplantation nephrectomy on quality of life in patients with autosomal dominant polycystic kidney disease.

Autor: Geertsema P; Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Gansevoort RT; Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Brenkman LPJ; Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Dekker SEI; Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands., Eleveld DVP; Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., de Fijter JW; Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands., Leliveld AM; Department of Urology, Expertise Center for Polycystic Diseases, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands., Levy M; Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Meijer E; Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Pol RA; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Schillern EEM; Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Sanders JF; Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Casteleijn NF; Department of Urology, Expertise Center for Polycystic Diseases, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. N.F.Casteleijn@umcg.nl.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2023 Apr; Vol. 41 (4), pp. 1193-1203. Date of Electronic Publication: 2023 Mar 17.
DOI: 10.1007/s00345-023-04349-4
Abstrakt: Purpose: In selected ADPKD patients, a nephrectomy is required in the work-up for a kidney transplantation. Because the impact of this procedure is unknown, we investigated the effect of pre-transplantation nephrectomy on quality of life in this group.
Methods: In this retrospective cohort study all ADPKD patients, ≥ 18 years, who received a kidney transplantation in 2 ADPKD expertise centers between January 2000 and January 2016, were asked to participate. Quality of life was assessed using three validated questionnaires on three time points. Nephrectomy was performed in preparation for transplantation.
Results: Two hundred seventy-six ADPKD patients (53 ± 9 years, 56.2% male) were included. 98 patients (35.5%) underwent native nephrectomy in preparation for transplantation, of which 43 underwent bilateral nephrectomy. Pre-transplantation, ADPKD-IS scores were worse in the nephrectomy group vs. no-nephrectomy group (physical: 2.9 vs. 2.3, p < 0.001; emotional: 2.0 vs. 1.8, p = 0.03; fatigue: 3.0 vs. 2.3, p = 0.01). Post-transplantation and post-nephrectomy, ADPKD-IS scores improved significantly in both groups, with a significantly higher improvement in the nephrectomy group. During follow-up, all scores were still better compared to pre-transplantation. Observed physical QoL (ADPKD-IS physical 1.3 vs. 1.7, p = 0.04; SF-36 physical 50.0 vs. 41.3, p = 0.03) was better post-transplantation after bilateral nephrectomy compared to unilateral nephrectomy. In retrospect, 19.7% of patients would have liked to undergo a nephrectomy, while the decision not to perform nephrectomy was made by the treating physician.
Conclusion: This study shows that pre-transplantation nephrectomy improves quality of life in selected ADPKD patients. Bilateral nephrectomy may be preferred, although the risk of additional complications should be weighted.
(© 2023. The Author(s).)
Databáze: MEDLINE
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