Introduction

1. 298 Renal transplant for PCKD 269 Files available for review 218 (No nephrectomy) 51* (pre-transplant nephrectomies) 3 (Laparoscopic) 48 + (Open) Multicenter audit of outcomes in patients with PCKD, with consideration to surgical approach when having a pre-transplant nephrectomy) No. 107 C.F. Taylor1, E.C. Chen2, A. Thakkar3, I. Michell2 1 St George Hospital, Sydney, 2 Austin Health, Victoria, 3 University of NSW, Sydney Posters Proudly Supported by: Introduction Polycystic kidney disease (PCKD) is an autosomal dominant disease that has the propensity to cause end stage renal failure. Overall PCKD contributes to approximately 10% of all patients with end stage renal failure1. A polycystic kidney may be removed; in preparation for a required transplant kidney or for direct symptomatic relief. Urologists frequently would remove a specimen via the groin when using a laparoscopic technique, which is in fact the same potential incision for the recipient kidney leading to complications. Previously when large incisions were made from open nephrectomies there were no issues for the transplant surgeon, however, as Urologists are increasingly attempting minimally invasive surgery, the long-term complications and intra-operative complications are yet to be assessed. Results * 27 (53%) cases performed to make space for transplant. 24 (47%) cases performed to symptom control. + A total of 5 (0.1%) complications were recorded.   Discussion In this study, 19% of patients had pre-transplant nephrectomy and this is comparable to current literature (20%)2. Interestingly it was noted that in one unit, bilateral nephrectomies was widely practiced with 70% of PCKD patients having bilateral nephrectomies prior to transplant and this perhaps relates to surgeon preference. Only 3 cases were performed laparoscopically and this may increase in the future as more surgeons are attempting minimally invasive surgery. The low overall complication rate (0.1%) does not reflect the degree of difficulty encountered by surgeons intra-operatively especially when prior surgery or inflammation has taken place in the retroperitoneum; i.e in cases where patients had previous pelvic surgery such as tubo-ovarian abscess or oophrectomy or when the kidney has been removed via a groin incision from the laparoscopic approach. Aim The aim was to determine if there were any differences in intra-operative or post-operative complications with patients receiving a transplanted kidney who had previously undergone a nephrectomy for PCKD. Methods Data from ANZDATA was collated for 6 hospitals across NSW and VIC health networks (St George, Westmead, Newcastle, Austin, Monash and St Vincents). A retrospective audit was performed evaluating patients with PCKD who had received renal transplants over the 19 year period (1991 to 2010). References 1)PA Gabow. Autosomal dominant polycystic kidney disease. N Engl J ed, 329 (1993) p 332 2)P Patel, C Horsfield, F Compton, J Taylor, G Koffman, J Olsburgh. Native nephrectomy in transplant patients with autosomal dominant poly cystic kidney disease. Ann R Coll Surg Engl. 2011 Jul;93(5):391-5 3)TF Fuller, TV Brennan, S Feng, S Kang, PG Stock, CE Freise. End stage polycystic kidney disease: Indications and timing of native nephrectomy relative to kidney transplant. J of Urol. Vol 174, Issue 6, December 2005, Page 2284-2288 Conclusions Retrospective studies have their known disadvantages such as the prolonged time frame of analysis and incomplete documentation. To assess the impact of laparoscopic surgery on the transplantation component, a prospective study is required. The future is likely to produce a larger percentage of laparoscopic nephrectomies for PCKD. The results support the theoretical belief that the retroperitoneal space should be avoided to enable ease of transplant surgery. Nevertheless, strong evidence supporting this recommendation is limited due to a small case volume. It is important to note that concomitant nephrectomies can be performed successfully despite potential complications from previous surgery3. Acknowledgements I would like to acknowledge ANZDATA and the renal units for their support.