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Robotic Kidney Transplantation from a Brain-Dead Deceased Donor in a Patient with Autosomal Dominant Polycystic Kidney Disease: First Case Report.

ABSTRACT: Background: Autosomal dominant polycystic kidney disease (ADPKD) is a common cause of end-stage renal disease (ESRD) and may pose significant technical challenges for kidney transplantation. Recently, robot-assisted kidney transplantation (RAKT) has been shown to achieve excellent patient and graft outcomes while reducing surgical morbidity. However, the vast majority of RAKT performed so far were from living donors and no studies reported the outcomes of RAKT in patients with ADPKD. Case Presentation: Herein, we describe the first successful case of RAKT from a brain-dead deceased donor in a 37-year-old patient with ESRD due to ADPKD. Conclusion: Our case highlights that RAKT can be safely performed by experienced robotic surgeons even in selected complex recipients such as patients with ADPKD and using grafts from deceased donors.

SUBMITTER: Vignolini G

PROVIDER: S-EPMC6083208 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Robotic Kidney Transplantation from a Brain-Dead Deceased Donor in a Patient with Autosomal Dominant Polycystic Kidney Disease: First Case Report.

Vignolini Graziano G Sessa Francesco F Greco Isabella I Pili Alessandro A Giancane Saverio S Sebastianelli Arcangelo A Siena Giampaolo G Gacci Mauro M Li Marzi Vincenzo V Campi Riccardo R Serni Sergio S

Journal of endourology case reports 20180801 1

<b><i>Background:</i></b> Autosomal dominant polycystic kidney disease (ADPKD) is a common cause of end-stage renal disease (ESRD) and may pose significant technical challenges for kidney transplantation. Recently, robot-assisted kidney transplantation (RAKT) has been shown to achieve excellent patient and graft outcomes while reducing surgical morbidity. However, the vast majority of RAKT performed so far were from living donors and no studies reported the outcomes of RAKT in patients with ADPK ...[more]

PMID: 30094337

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Project description:Hypertension is common in autosomal dominant polycystic kidney disease (ADPKD) and is associated with increased total kidney volume, activation of the renin-angiotensin-aldosterone system, and progression of kidney disease.In this double-blind, placebo-controlled trial, we randomly assigned 558 hypertensive participants with ADPKD (15 to 49 years of age, with an estimated glomerular filtration rate [GFR] >60 ml per minute per 1.73 m(2) of body-surface area) to either a standard blood-pressure target (120/70 to 130/80 mm Hg) or a low blood-pressure target (95/60 to 110/75 mm Hg) and to either an angiotensin-converting-enzyme inhibitor (lisinopril) plus an angiotensin-receptor blocker (telmisartan) or lisinopril plus placebo. The primary outcome was the annual percentage change in the total kidney volume.The annual percentage increase in total kidney volume was significantly lower in the low-blood-pressure group than in the standard-blood-pressure group (5.6% vs. 6.6%, P=0.006), without significant differences between the lisinopril-telmisartan group and the lisinopril-placebo group. The rate of change in estimated GFR was similar in the two medication groups, with a negative slope difference in the short term in the low-blood-pressure group as compared with the standard-blood-pressure group (P<0.001) and a marginally positive slope difference in the long term (P=0.05). The left-ventricular-mass index decreased more in the low-blood-pressure group than in the standard-blood-pressure group (-1.17 vs. -0.57 g per square meter per year, P<0.001); urinary albumin excretion was reduced by 3.77% with the low-pressure target and increased by 2.43% with the standard target (P<0.001). Dizziness and light-headedness were more common in the low-blood-pressure group than in the standard-blood-pressure group (80.7% vs. 69.4%, P=0.002).In early ADPKD, the combination of lisinopril and telmisartan did not significantly alter the rate of increase in total kidney volume. As compared with standard blood-pressure control, rigorous blood-pressure control was associated with a slower increase in total kidney volume, no overall change in the estimated GFR, a greater decline in the left-ventricular-mass index, and greater reduction in urinary albumin excretion. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; HALT-PKD [Study A] ClinicalTrials.gov number, NCT00283686.).

Dataset Information

Robotic Kidney Transplantation from a Brain-Dead Deceased Donor in a Patient with Autosomal Dominant Polycystic Kidney Disease: First Case Report.

Publications

Robotic Kidney Transplantation from a Brain-Dead Deceased Donor in a Patient with Autosomal Dominant Polycystic Kidney Disease: First Case Report.

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