Polycystic kidney disease (PKD) is an inherited, progressive disorder in which multiple clusters of fluid-filled cysts grow inside the kidneys—enlarging them, damaging them, and often causing kidney failure. The results of a recent Mayo Clinic study, led by transplant surgeon Mikel Prieto, MD, and published in the American Journal of Transplantation, provide a new treatment option to the nearly 600,000 people in the U.S. who are living with PKD.*

The problem

Due to the risks involved in removing an original kidney before or during transplant surgery, the original kidney is usually left inside the patient’s body, and the new kidney is attached lower down in the cavity. In cases of high blood pressure, ongoing infection, or significant enlargement (as with PKD), the original kidney will be removed, but generally not until the recipient has healed from transplant surgery and the new kidney has been accepted, which can take several months. 

Dr. Prieto confirmed this. “Some patients with polycystic kidney disease have two big problems,” he said. “The first one is that their kidneys do not work and they need a kidney transplant. The other one is that they have very large kidneys that can cause pain and other problems…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.”

The solution

In 2014, Dr. Prieto started offering a surgery that could potentially solve this issue for patients. To avoid both the risks of removing the diseased kidney through open surgery at the time of transplant and the long wait for a second surgery, Dr. Prieto removed the diseased kidney laparoscopically (through narrow tubes inserted into small incisions in the abdomen) at the same time as the kidney transplant was performed. 

For the study, Prieto and his team compared the results of:

• 51 patients who underwent dual surgery 
• 97 who had only undergone the living donor kidney transplant

All surgeries took place between January 2014 and October 2019.

The results

Study results revealed that:

• Kidney function for both groups following surgery was the same.
• Risk of complications for both groups was the same.
• Patients who had dual surgery only spent one extra day in the hospital (four (4) days for those who had dual surgery vs. three (3) days for non-dual).
• Patients who had dual surgery required extra care immediately after surgery.
• Long-term outcomes were comparable for both groups.

The findings confirm that, despite the necessary additional aftercare, the dual-surgery format is a safe and effective treatment option for people with kidney failure from PKD.

*Mayo Clinic News Network. (2020, Sept. 29). Study finds pioneering dual surgery a safe option for patients with polycystic kidney disease. https://newsnetwork.mayoclinic.org/discussion/study-finds-pioneering-dual-surgery-a-safe-option-for-patients-with-polycystic-kidney-disease/