Kidney Week

Abstract: SA-PO0139

Native Nephrectomy Is Associated with Lower Mortality in Patients with ADPKD Undergoing Kidney Transplantation: A Nationwide Cohort Study

Session Information

• ADPKD and Cystic Kidney Disease - 3
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Genetic Diseases of the Kidneys

• 1201 Genetic Diseases of the Kidneys: Cystic (Monogenic)

Authors

• Cho, Yoon Jung, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Yoon Jung Cho, MD

• Jang, Yoonjoo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Yoonjoo Jang, MD

• Gu, Juyeon, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Juyeon Gu, MD

• Lee, Kyungho, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Kyungho Lee, MD, PhD

• Jeon, Junseok, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Junseok Jeon, MD, PhD

• Lee, Jung eun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Jung eun Lee, MD, PhD

• Huh, Wooseong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Wooseong Huh, MD, PhD

• Jang, Hye Ryoun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Hye Ryoun Jang, MD, PhD

Background

Native kidney nephrectomy is performed in a substantial number of patients with autosomal dominant polycystic kidney disease (ADPKD) who undergo kidney transplantation (KT), with reported rates varying widely across centers. However, an evidence-based algorithm to guide whether to perform native kidney nephrectomy with KT is lacking. We aimed to compare KT outcomes between ADPKD patients who received nephrectomy before or at the time of KT and those who underwent KT alone.

Methods

Using data from the Health Insurance Review and Assessment Service (HIRA) and the Korea National Health Insurance Service (NHIS), KT recipients in Korea between 2004 and 2020 were categorized into PKD and non-PKD groups. The PKD group was further subdivided based on whether patients underwent pre-transplant or simultaneous native nephrectomy (PKD-nephrectomy vs. PKD-KT alone). All-cause mortality and death-censored graft failure were analyzed using Cox proportional hazards models.

Results

Among 21,404 KT recipients, 1,142 with PKD were identified, comprising 458 in the PKD-nephrectomy group and 684 in the PKD-KT alone group. The incidence rate of all-cause mortality was significantly lower in the PKD-nephrectomy group than in the PKD-KT alone group (6.79 vs. 14.15 per 1,000 person-years, P=0.040), with an unadjusted hazard ratio (HR) of 0.48 (95% confidence interval [CI], 0.23–0.82). After adjusting for age, sex, income status, diabetes, hypertension, dyslipidemia, cardiovascular disease, and immunological risk factors, the adjusted HR for mortality remained significant at 0.57 (95% CI, 0.32–0.99). Compared with non-PKD recipients, the PKD-nephrectomy group demonstrated significantly lower adjusted HRs for both all-cause mortality (0.59 [0.36–0.95]) and death-censored graft failure (0.51 [0.29–0.89]), whereas the PKD-KT alone group showed no significant difference (mortality, 1.06 [0.81–1.39]; graft failure, 0.94 [0.67–1.33]).

Conclusion

In patients with ADPKD undergoing KT, native kidney nephrectomy before or at the time of KT was associated with significantly lower all-cause mortality compared with KT alone, and with both lower mortality and superior graft survival compared with non-PKD recipients. These nationwide real-world findings support the role of native nephrectomy as a potentially beneficial strategy in selected ADPKD patients undergoing KT.