Renal transplantation in Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Abstract

Transplantation is the optimal choice for renal replacement therapy in patients with autosomal dominant polycystic kidney disease (ADPKD). However, some specific issues should be addressed before transplantation, including nephrectomy of native kidneys, cystic liver involvement, screening for intracranial aneurysms and living related-donor transplantation. After kidney transplantation, patient and graft survival rates are excellent and the size of native kidneys typically declines. Nevertheless, a number of renal and extrarenal complications have been documented in kidney transplant recipients with ADPKD. In particular, renal cyst infections may occur in patients who did not undergo pretransplant nephrectomy. Moreover, an increased risk in new-onset diabetes mellitus and non-melanoma skin cancer has been reported, even though recent studies challenged these findings. In patients with ADPKD who did not undergo preventive nephrectomy, the risk of malignancy in native kidneys after renal transplantation is comparable to that reported in patients with other nephropathies. There is no evidence supporting the preferential use of mammalian target of rapamycin inhibitors as immunosuppressive drugs in transplant recipients with ADPKD.