Abstract Autosomal dominant polycystic kidney disease (ADPKD) is one of the leading causes of kidney failure in adults. Many of these patients subsequently require kidney transplantation. There is currently vast debate on whether these patients should undergo native nephrectomy, and if so, the timing of the nephrectomy, pre-transplant, post-transplant, or simultaneously alongside transplantation. There is also uncertainty in the literature on whether unilateral or bilateral nephrectomy should be undertaken. Therefore, this narrative review aimed to summarize the most up-to-date literature regarding the timing of native nephrectomy in ADPKD patients requiring kidney transplantation. Papers were selected for inclusion using keywords “kidney transplantation or transplant or renal transplantation or transplant” and “nephrectomy” and “polycystic kidney disease or ADPKD”, including papers published only in the last 10 years. This review found that in patients with ADPKD and significant symptoms due to enlarged kidneys, pre-transplant nephrectomy resulted in comparable outcomes of the graft and operation when compared with transplantation alone. Pre- and post-transplant nephrectomy showed comparable outcomes, but post-transplant nephrectomy may result in shorter waiting list times and length of hospital stay. Simultaneous nephrectomy was shown to have lower rates of transplant rejection and delayed graft function compared to pre-transplantation nephrectomy; however, the risk of intraoperative blood transfusions must not be ignored. Insufficient studies comparing unilateral and bilateral nephrectomy were identified, thereby limiting comparisons. Further prospective studies and randomized control trials are warranted to compare simultaneous nephrectomy to post-transplant nephrectomy, as well as unilateral and bilateral nephrectomy to inform the clinical practice.
Alazzawi et al. (2026) studied this question.