STAGED PRE-EMPTIVE TRANSPLANT AND NATIVE NEPHRECTOMY IN ADPKD: A TECHNOLOGICALLY ASSISTED CASE REPORT alexrossano@yahoo.com

PE049

STAGED PRE-EMPTIVE TRANSPLANT AND NATIVE NEPHRECTOMY IN ADPKD: A TECHNOLOGICALLY ASSISTED CASE REPORT

4

Mexico

Poster Exhibition only

Autosomal dominant polycystic kidney disease (ADPKD) is a major hereditary cause of end-stage renal disease. Although pre-emptive kidney transplantation offers benefits such as superior graft and patient survival, better quality-adjusted life years, and long-term cost-effectiveness, only 9–24% of eligible patients undergo this approach.

A 55-year-old woman with end-stage renal disease secondary to ADPKD underwent three surgical procedures over five months. Advanced technologies including indocyanine green (ICG) and an intelligent insufflation system (AirSeal) were utilized.

First procedure: Laparoscopic resection of hepatic cysts and cholecystectomy for chronic acalculous cholecystitis and two large cysts. AirSeal (9 mmHg) optimized pneumoperitoneum, and ICG assisted biliary identification. Second procedure: Living donor kidney transplant one month later, using the Lich-Gregoir technique. Immediate graft function was achieved with 109 minutes of cold ischemia. Postoperative Doppler showed a resistance index of 0.5. The patient was discharged on day five with creatinine decreased from 4.73 to 1.75 mg/dL. The donor underwent hand-assisted laparoscopic left nephrectomy using AirSeal (10 mmHg) and ICG; recovery was uneventful. Third procedure: Bilateral open nephrectomy due to graft compression and severe back pain. Each kidney weighed ~1600 grams. ICG guided perfusion and ureteral dissection. At 19 months, renal function remains stable (75 ml/min/1.73 m²).

Although existing literature suggests surgical sequencing does not impact survival in ADPKD patients, this case emphasizes the clinical benefit of a structured, phased surgical approach. The combined use of ICG and AirSeal enhanced precision, safety, and recovery, offering a reproducible strategy for complex ADPKD cases.