1. Pre transplant nephrectomy , our experience in Prince Hussien Center of Urology and Organ transplantation
By : Dr. Ghaith Gsous
third year general surgery resident
Supervisor : Dr.Muhanad Al-Naser
Consultant of Urology

2. Objective 
to review our experience in pre transplant nephrectomy and discuss the indications , causes and outcome for this procedure and compare it  with international literature.

3. Introduction Indications of nephrectomy
Indications of kidney transplant
Indications for native nephrectomy and transplant
Types of native nephrectomy with transplant
Our experince
Comparing to international literature
conclusion

4. Indications of nephrectomy
Benign conditions :
irreversable damaged kidney due to:
chronic infection .
obstruction .
trauma .
renal TB .
renovascular hypertension .
polycystic kidney disease .
transplant .
Malignant : renal cell carcinoma , chromophobe carcinoma

5. Indications of kidney transplant
End stage renal disease due to :
diabetes
hypertension
glomerulonephritis
cystic kidney
focal segmental glomerulosclerosis , etc .

6. Indications for native nephrectomy and transplant
polycystic kidney disease ( most common ) .
prevent recurrent Urinary tract infection pyelonephritis due to renal stones .
vesicouretral reflux .

7. Types of native nephrectomy with transplant
Native nephrectomy pre transplant
Native nephrectomy and transplant in same session
Native nephrectomy after transplant

8. Our experince Materials and Methods :
-this prospective study carried out in Prince Hussien Center Of Urology and Organ Transplantation from 2010 to 2015 on 28 patients who underwent nephrectomy pretransplant for different causes .

9. Results : out of 28 patients there was :
(18 patients) had nephrectomy pretransplant due to polycystic kidney disease .
 (6 patients) had nephrectomy to prevent recurrent Urinary tract infection due to renal stones or to prevent pyelonephritis .
(4 patients) due to vesicouretral reflux.

10. Specific points : All donors are living donor.
Dialysis done 1 day before surgery
3 months the interval between native nephrectomy and transplant surgery
Bilateral native nephrectomy done in 8 patients.
Midline incision done for nephrectomy .

11. Dr.Mohannad Al-Naser
Huge PCK

12. Complications
1-Splenic injury in one pateint , treated with splenectomy . 2-Bowel injury in one patient , treated by primary repair .

13. Comparing with international studies
Common cause of native nephrectomy and transplant
Timing of native nephrectomy according to transplant surgery
Outcome and Conclusion

14. Common complaints with PCKD
 St Thomas' Hospital( ) = 31 cases
Renal Transplant Unit Central Manchester University Hospital
( )= 32 cases
Prince Hussien center ( )= 16 cases
Common complaints with PCKD
UTI (14 pt)
Pain (12 pt)
Susp.tumor (3 pt)
Hematuria (1 pt)
No space (1 pt)
Pain
No space
Hematuria
Reccurnt infection
No space(10 pt )
Pain (3 pt )
Hematuria (2 pt )
Infected cyst (1pt)
Timing of native nephrectomy
Pre transplant (10 pt)
Post transplant (20 pt)
In same session (1 pt)
Pre transplant (20 pt)
Post transplant (12 pt )
Pre transplant nephrectomy ( regardless the indication )
Outcome
Mortality 3%
Morbidity 65%
Mortality (3pt , 2 in pre transplant group )
No mortality
Splenic injury (1 pt )
Bowel injury (1pt )
Conclusion
The timing of NN is variable and dictated by indication
Post-transplant unilateral nephrectomy appears to be the safest approach

15. Conclusion
PCKD is the most common cause of native nephrectomy and kidney transplant.
Timing the native nephrectomy still controversial , our policy is Pre-Transplant nephrectomy in all cases , the international literature support the Post- Transplant nephrectomy .
Our outcome and results the same with international centers .

16. Question for discussion
What is the optimal time for native nephrectomy , is it Pre-Transplant , Post- Transplant or in one session ?

17. My opinion
1- the indication for native nephrectomy should be considered at first. 2- patient post-transplant will be on immunosuppressant medications and the surgery for native nephrectomy will increase risk of infection of rejection . 3- the cost will be less on hospital if the nephrectomy done with transplant in same session . 4- we don’t have to put the patient on risk of two major surgery .

18. Thank you