Polycystic Kidney Disease: One Diagnosis – One Surgery

Dec 2, 2022 | Kristin Eggebraaten | @keggebraaten

When your kidneys fail, you need “renal replacement therapy”.  The causes for kidney disease leading to kidney failure are many and the renal replacement therapy comes with two options:  Dialysis or kidney transplantation.  Kidney transplantation, when a kidney donor is available, is generally considered a better option for these patients because it affords a better quality of life and long-term survival.  In most cases, when a kidney transplant is done, the native kidneys are not removed.  The new kidney is placed in the lower abdomen and the native kidneys are left in place.

However, there is a genetic disease, called polycystic kidney disease (PKD), in which the kidneys can grow to a very large size and cause symptoms such as back pain, abdominal distension, gastrointestinal symptoms, and intermittent chronic bleeding or infections.  In these cases, the removal of these kidneys may be very beneficial for the patient receiving a kidney transplant.

Historically, medical centers have transplanted patients who suffer from PKD with two surgeries. One surgery was to give them a new kidney transplant, and the other surgery, which could be done before or after the transplant, was the bilateral nephrectomy to remove both diseased kidneys.  The bilateral nephrectomy procedure can be a very challenging operation given the very large size of these polycystic kidneys. Depending on the transplant program, this surgery is done through a large midline incision with an open technique or through a small incision using the laparoscopic technique.  This two-step approach is still the standard practice in most transplant centers.

For the past eight years, at Mayo Clinic, we have been offering the option of performing a simultaneous laparoscopic bilateral native nephrectomy and kidney transplantation.  During this procedure, both kidneys are removed laparoscopically before a new kidney transplant is placed. This all happens during the same surgical procedure.  This approach allows for all the patient’s problems to be resolved at once without the need for a 2nd surgery.

"Some patients with polycystic kidney disease have two big problems. The first one is that their kidneys don’t work and they need a kidney transplant. The other one is that they have very large kidneys that can cause pain and other problems," says Dr. Mikel Prieto, a transplant surgeon at Mayo Clinic, who performs this procedure. "If you fix one problem with the transplant, you still have the other problem to fix. It's very unsatisfying for patients who can be miserable with these kidneys to be told they will need to wait six months after the transplant to have them removed.  For this reason, we decided to offer the combined procedure"

To date, Mayo Clinic has performed close to 300 laparoscopic bilateral native nephrectomies for large polycystic kidneys, of which 100 where in combination with a kidney transplant.  “This has been our standard approach for the past eight years, for patients who have large symptomatic polycystic kidneys who also need a kidney transplant.  While the recovery from the surgery is a little bit slower than a regular kidney transplant, the outcomes with the procedure have been equivalent to the kidney transplant alone” says Dr. Prieto.  You can learn more about this procedure and Dr. Prieto’s work on our News Network.

 

Have you had this combined surgery? How did you feel when your cyst-filled kidneys were gone?

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