transplanted into two young patients with end-stage renal disease who were 19 ... may take 12.5 years to develop end-stage renal disease after transplantation.
Nephrol Dial Transplant (2001) 16: 410±411
Case Report
Polycystic kidney patient as a cadaveric donor: is it appropriate? Yan-Shen Shan, Po-Chang Lee, Edgar D. Sy, Chung-Jye Hung and Yih-Jyh Lin Division of Transplantation, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
Keywords: abnormal kidneys; autosomal dominant polycystic kidney disease (ADPKD); cadaveric donor; kidney transplantation
Introduction Shortage of cadaver kidney donors has prompted occasional use of abnormal kidneys such as those affected by autosomal dominant polycystic kidney disease (ADPKD) with preserved renal function w1±3x. ADPKD is a hereditary disorder characterized by slow progressive deterioration of renal function due to cystic changes w4x. Upon serious consideration of quality-of-life improvement with a functioning kidney graft, there is justi®cation for use of cadaveric polycystic ADPKD kidneys when the intervals between progression to end-stage renal disease and graft survival period are compared. We report our experience of transplantation of two ADPKD kidneys with normal graft function.
Case The cadaveric donor was a 21-year-old male with left frontotemporal subdural haemorrhage and right temporal subarachnoid haemorrhage following a traf®c accident. There was no known family history of renal disease. Preoperative procurement evaluation of the heart revealed normal chamber dilatation and mild hyperkinesia of the interventricular septum at the basal part with an ejection fraction of 0.707. The serum creatinine concentration of the donor was 88 mmolul. The size of the grafted kidneys was approximately 12 cm in longitudinal axis. Multiple small cysts, 3±5 mm in size, were found in both kidneys during Correspondence and offprint requests to: Po-Chang Lee, MD, Chief, Division of Transplantation, Department of Surgery, National Cheng Kung University Hospital, No. 138 Sheng-Li Rd, Tainan, Taiwan, ROC. #
procurement of organs in December 1998. After serious consideration, these two polycystic kidneys were transplanted into two young patients with end-stage renal disease who were 19 and 20 years old, respectively. The postoperative courses were uneventful. Follow-up sonographic studies 1 year later showed multiple small cysts 2±13 mm in diameter. The length of the two grafted kidneys was 12.2 cm and 12.9 cm, respectively. Renal functions were normal, with serum creatinine concentration of 115 and 123 mmolul. No cyst-related complications have been found up to the present.
Discussion ADPKD is a hereditary nephropathy characterized by multiple renal cysts, with slow progressive deterioration of renal function. It often terminates in renal failure and accounts for 2±9% of this population. The symptoms of ADPKD do not generally develop until adulthood; 85% of carriers are asymptomatic until the fourth decade of life w4x. In Dalgard's retrospective study, the mean age for diagnosis of ADPKD was 47.2 years, while Singh reported that the mean age at the start of ESRD treatment was 47.3"15.2 years w5,6x. There is often a period of more than 10 years when patients with polycystic kidneys develop symptoms of end-stage renal disease. Howard et al. w7x reported that an ADPKD donor kidney with cysts size up to 34 mm may take 12.5 years to develop end-stage renal disease after transplantation. Based on the age of a 21-year-old cadaver donor there should be at least a 10-year period of kidney function. Over the past 40 years, great improvements have been made in graft survival with some forms of cyclosporin-based immunosuppression. One-year and 3-year graft survivals of 85 and 75% respectively are possible for normal kidney donations. Furthermore, previous reports showed that polycystic kidneys with normal renal function and preserved renal cortical mass could be used for transplantation w1,2x and disappearance of the cysts may even occur, as reported by Spees w1,3x. Ettenger et al. w8x compared mortality between renal cadaveric transplant patients
2001 European Renal Association±European Dialysis and Transplant Association
Polycystic kidney patient as a cadaveric donor: is it appropriate?
and patients on dialysis who were or were not waiting for transplantation. He found that the mortality rate is lower in the renal transplant patients after 2 years follow-up. In consideration of quality of life with a good functioning kidney and the shortage of donors, a polycystic kidney with good renal function may be used as a donor kidney based on the estimated time for the donor kidney to fail and the graft survival period on immunosuppression.
References 1. Siegal B. The polycystic kidney donor. Transplantation 1992; 54: 1131 2. Mancini G, Camparini L, Salvadori M. Transplant of a polycystic kidney because of organ shortage. Transplant Proc 1990; 22: 376
411 3. Spees EK, Orlowski JP, Schorr WJ, Temple DM, Fink DW, Bryno AJ. Successful use of polycystic cadaver donor kidney. Transplant Proc 1990; 22: 374±375 4. Milutinovic J, Fialkow PJ, Phillips LA, Agoda LY, Bryant JI, Denney JD. Autosomal dominant polycystic kidney disease: Early diagnosis and data for genetic counselling. Lancet 1980; 1: 1203±1206 5. Dalgard OZ. Bilateral polycystic disease of the kidneys. A followup of two hundred and eighty-four patients and their families. Acta Med Scand 1957; 158 [Suppl. 328]: 13±255 6. Singh S, Hariharan S. Renal replacement therapy in autosomal dominant polycystic kidney disease. Nephron 1991; 57: 40±44 7. Howard RJ, Reed AI, Van der Werf WJ, Silkensen JA, Patton PR, Scornik JC. Development of polycystic disease in a kidney 10 years after transplantation. Transplantation 1999; 68: 1620 8. Ettenger RE, Agodoa LYC, Held PJ, Port FK. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and patients of a ®rst cadaveric transplant. N Engl J Med 1999; 341: 1725±1730 Received for publication: 13.1.00 Accepted in revised form: 15.9.00
Editor's note Please see also Editorial Comment by R.A.P. Koene, pp. 227±229.
