Outcomes After Bilateral Native Nephrectomy in Autosomal Dominant Polycystic Kidney Disease: A Contemporary Single-Centre NHS Cohort Study (2018–2024)

Background/Objectives: Bilateral native nephrectomy (BNN) is undertaken selectively in autosomal dominant polycystic kidney disease (ADPKD) to relieve symptoms or to create iliac fossa space for transplantation. Contemporary UK National Health Service outcome data are scarce. We describe indications, morbidity and mortality after open BNN at a UK tertiary transplant centre. Methods: This is a retrospective descriptive cohort study of 34 consecutive adults with ADPKD undergoing open BNN between August 2018 and September 2024, reported per STROBE, without a comparator group. Pre-specified primary outcomes were length of stay (LoS) and Clavien–Dindo (CD) ≥III complications. Exploratory analyses used regression on log(LoS), with a sensitivity analysis excluding one outlier, and Firth-penalised logistic regression. Results: Median age was 55 years (IQR 51–62); 29 patients (85.3%) were dialysis-dependent, and 5 (14.7%) had a functioning allograft. No procedure was concurrent with transplantation. The commonest indication was insufficient space for a kidney graft (21/34, 61.8%). Median LoS was 8 days (IQR 7–10). CD≥III complications occurred in 5/34 (14.7%; 95% CI 6.4–30.1%) and transfusion in 6/34 (17.6%); grade I–II complications were not systematically recorded. There were no in-hospital, 30-day or 90-day deaths. Over a median potential follow-up of 53 months, 15/34 (44.1%) underwent transplantation. Transfusion was associated with longer LoS (β = 0.58; p = 0.035), but not after excluding one outlier (p = 0.348), and was not significantly associated with CD≥III (OR 4.05; 95% CI 0.54–28.4). No invasive malignancy was found in 29 histopathology reports. Conclusions: In this small single-centre series, open BNN was performed mainly to enable transplantation, with no early mortality and a 14.7% CD≥III rate. These descriptive baseline data cannot establish benefit relative to unilateral or no nephrectomy.