Native nephrectomy and arterial embolization of native kidney in autosomal dominant polycystic kidney disease patients: indications , timing and postoperative outcomes

INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common causes of a need of renal replacement therapy. The need (elective vs. systematic) and timing of native kidney nephrectomy (before, after or during kidney transplantation) is a matter of debate and alternatives to surgery, mainly transcatheter arterial embolization have been explored. We performed a systematic review to report all available evidence on postintervention outcomes of native nephrectomy and arterial embolization in ADPKD patients.EVIDENCE ACQUISITION: A search on Medline, Embase, and Cochrane databases was performed to identify all stud-ies reporting outcomes of native nephrectomy or arterial embolization in APKDs. EVIDENCE SYNTHESIS: Concerning native nephrectomy, a total of 3626 patients in 37 studies were included with 735, 210 and 2681 patients who underwent native nephrectomy respectively before, after or during kidney transplanta-tion. Major complications were 12.2% in unilateral nephrectomy before transplantation, 25.0% in bilateral nephrectomy before transplantation, 17.7% in unilateral nephrectomy during transplantation, 20.8% in bilateral nephrectomy during transplantation and 23.8% in unilateral and bilateral nephrectomy after transplantation. A total of 230 patients in 7 series of arterial embolization were included. All arterial embolization were performed before transplantation. Mean volume reduction ranged from 36.3% at 3 months to 49% at 6 months. The major postintervention complication rate was 1%.CONCLUSIONS: Unilateral native nephrectomy before kidney transplantation was associated with the lowest major postoperative complication rate and appears to be the preferred strategy. Arterial embolization reduces kidney volume by 49% at 6 months. Arterial embolization could be considered when the reduction in size of the native kidney is not urgent.(Cite this article as: Prudhomme T, Boissier R, Hevia V, Campi R, Pecoraro A, Breda A, et al.; EAU -Young Academic Urologist (YAU) group of Kidney Transplant. Native nephrectomy and arterial embolization of native kidney in autoso-mal dominant polycystic kidney disease patients: indications, timing and postoperative outcomes. Minerva Urol Nephrol 2023;75:17-30. DOI: 10.23736/S2724-6051.22.04972-2).