Ramírez-Oliveros BG, Montalvo-Javé EE, Noriega-Salas L, Brener-Kushner J, Río-Martínez LJ, Soto-Tolosa MAN, Meixueiro-Daza LA, Rincón-Zepeda R, Rossano-García A

Language: Spanish
References: 10
Page: 42-44
PDF size: 271.48 Kb.

ABSTRACT

Introduction: polycystic kidney disease is the fourth leading cause of chronic kidney disease (CKD) and require pretransplant nephrectomy. Objective: describe the surgical sequence in a 55-year-old woman with autosomal dominant polycystic kidney (ADPKD). Material and methods: we performed three surgical procedures in a woman with CKD secondary to ADPKD of 13 years of evolution from June to November 2023 which are as follows: resection of two liver cysts and laparoscopic cholecystectomy, related living donor renal transplant and bilateral open nephrectomy, all of them with the use of innovative technology. Results: the first procedure was performed for risk reduction and two cysts of 3.5 × 1.6 × 1.5 cm and 3.3 × 2.0 × 1.4 cm and chronic cholecystitis were reported. The second one was performed one month later; the patient had previous creatinine values of 4.73. The graft was positioned in the right iliac fossa where end-to-side anastomosis of renal vessels was performed with external iliac vessels and uretero-vesical anastomosis was executed with the Lich-Gregoir technique; the total ischemia time was 109 minutes and the kidney presented immediate function. At 48 hours, a Doppler ultrasound was performed, which reported a renal artery resistance index of 0.5, with homogeneous cortical perfusion, without collections, vessels and ureter without stenosis or thrombosis; therefore, the patient was discharged 5 days after the transplant with optimal graft function and creatinine levels of 1.75. In the last procedure two kidneys of 1.6 kg each were obtained and pathology reported adult polycystic disease with interstitial fibrosis, chronic inflammation, dystrophic calcification, tubular and glomerular atrophy. At the moment she has stable graft function and went from having creatinine levels of 4.73 to 1.2 and her glomerular filtration rate went from 9.68 to 50.84. Conclusions: In our experience, performing liver cyst resection at the beginning reduced the possibility of risks in the transplant, which was anticipated for better graft acceptance; in addition, high specialty surgery with the use of ICG and special sutures reduced ischemia times and provided greater safety to the procedure. Subsequently, nephrectomy was performed and after this procedure there were no complications and graft function did not diminish. So our initial experience can serve as a guide for future studies in search of generating a sequential surgical treatment of patients with PKD for an adequate graft acceptance and improvement in quality of life.

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