대한신장학회

논문분류	춘계학술대회 초록집
제목	The Effect of Native Nephrectomy on Blood Pressure Fluctuation and Graft Outcome in ADPKD Kidney Transplantation
저자	Hyung Ah Jo1, Hayne Cho Park1, Hyunsuk Kim1, Miyeun Han1, Hyuk Huh1, Jong Cheol Jeong2, Kook-Whan Oh1, Jae Seok Yang2, Young Hwan Hwang3, Curie Ahn1
출판정보	2013; 2013(1):
키워드	신장 이식, 상염색체 우성 다낭성 신종, 혈압 변동/ Kidney transplantation, ADPKD, Blood pressure fluctuation
초록	Background: Patients with autosomal dominant polycystic kidney disease (ADPKD) often undergo native nephrectomy upon kidney transplantation. However, its role and necessity remain controversial. This is a single center, retrospective study to determine the impact of native nephrectomy on blood pressure fluctuation and graft outcome in ADPKD patients. Methods: We retrospectively reviewed 45 cases of kidney transplantations performed with simultaneous nephrectomy (n=25) or without native nephrectomy (n=20) at Seoul National University Hospital between 1999 and 2012. The glomerular filtration rate (GFR) was estimated by MDRD equation. We evaluated and compared immediate postoperative mean arterial blood pressure and following graft function between non-nephrectomy and simultaneous nephrectomy groups. Results: Among 45 cases, 25 patients underwent simultaneous native nephrectomy. The reasons for nephrectomy partly included huge size of native kidneys (n=11, 44.0%) and previous infection history (n=1, 4%). Baseline characteristics including pre-operative mean arterial blood pressure (119.7±17.4 vs 114.8±13.5 mmHg, p=0.213), serum creatinine (6.53±2.11 vs 7.09±2.70 mg/dL, p=0.477) and MDRD-GFR (9.24±3.57 vs 10.53±10.08 mL/min/1.73m2, p=0.713) were similar between non-nephrectomy and simultaneous nephrectomy groups. However, the immediate post-operative mean arterial blood pressures were lower in nephrectomy group (Day 1, 116.2±16.3 vs 108.0±17.9 mmHg, p=0.141; Day 2, 115.1±15.0 vs 113.0±15.8 mmHg, p=0.687; Day 3, 123.6±12.7 vs 113.5±17.1 mmHg, p=0.019). In addition, the serum creatinine was significantly elevated in the nephrectomy group (post-op 1 month, 1.15±0.21 vs 1.46±0.90 mg/dL, p=0.08; post-op 3 month, 1.17±0.22 vs 1.59±1.27 mg/dL, p=0.044; post-op 6 month, 1.14±0.18 vs 1.65±1.64 mg/dL, p=0.009). Conclusions: Simultaneous native nephrectomy during kidney transplantation in the ADPKD patients may lower systemic blood pressure and subsequently result in graft dysfunction.
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