Less is More: Robotic Kidney Transplantation in Polycystic Kidney Disease Without Preemptive or Simultaneous Native Nephrectomy.

BACKGROUND

Autosomal dominant polycystic kidney disease (ADPKD) often prompts pre-transplantation or simultaneous native nephrectomy.

METHODS

We reviewed adult patients with ADPKD who underwent RKT without native nephrectomy at one transplant centre. Native kidney volume (NKV) and estimated abdominopelvic cavity volume (EACV) were estimated using ellipsoid approximations from cross-sectional imaging, and a Spatial Occupancy Ratio (SOR = combined NKV/EACV) was derived to quantify anatomical crowding.

RESULTS

Sixteen patients underwent RKT for ADPKD without preemptive native nephrectomy, with a median SOR of 24.7%. Median warm ischaemia and operative times were 37 and 267 minutes, respectively, with an estimated blood loss of 50 mL. Increasing SOR demonstrated a moderate but significant inverse correlation with graft volume (r = -0.52, p = 0.038) and a weak positive correlation with operative time (r = 0.07, p = 0.80).

CONCLUSIONS

RKT without native nephrectomy appears feasible across a broad spectrum of anatomical abdominopelvic occupancy, supporting a selective rather than routine approach to nephrectomy.