Combined liver–kidney transplantation for polycystic liver and kidney disease: analysis from the United Network for Organ Sharing dataset

Background & Aims: The purpose of this study was to evaluate predictors of outcomes in combined liver–kidney transplants for polycystic liver and kidney disease. Methods: We queried the United Network for Organ Sharing dataset for combined liver–kidney transplants performed from 1988 to 2013. Results: Out of 107 patients who had combined liver–kidney transplants for polycystic liver and kidney disease, 84 were women (78.5%) with a mean age of 54.9 ±7.2 years. Kaplan–Meier analysis demonstrated that patients undergoing liver–kidney transplantation for polycystic liver and kidney disease had better survival than patients with polycystic liver disease undergoing liver transplant alone and those undergoing liver–kidney transplantation for other indications. This group had a 1-, 3- and 5-year survival of 91%, 90% and 90%, respectively. Multivariable analysis demonstrated that an indication of polycystic liver and kidney disease for combined liver–kidney transplant (hazard ratio, 0.29; 95% confidence interval, 0.129–0.526; P < 0.001) and Model for End-Stage Liver Disease score (hazard ratio, 1.271; 95% confidence interval, 1.093–1.477; P = 0.002) are independently associated with patient survival. In a propensity score analysis adjusting for age, gender, cold ischaemia time and total bilirubin and excluding hepatitis C, we found that patients transplanted with combined liver–kidney for other indications have similar survival compared with our study group. Conclusions: Combined liver–kidney transplantation for polycystic liver and kidney disease can achieve good outcomes in selected patients. On Cox regression analysis, patients with polycystic liver and kidney disease undergoing liver–kidney transplantation had better survival compared with patients with combined liver–kidney for other indications. After excluding hepatitis C patients, those transplanted for polycystic liver and kidney disease vs other indications had similar survival after combined liver–kidney transplantation. Interestingly, patients in the combined polycystic liver and kidney disease group have significantly better outcomes than patients with polycystic liver disease undergoing liver transplant alone.