Evolution of kidney function after liver transplantation for adult polycystic liver disease and indications for combined liver and kidney transplantation

Darius, Tom;Patris, Alexander;Hassoun, Ziad;Monbaliu, Diethard;Lerut, Jan;et.al.
(2011) 15th Congress of the European Society for Organ Transplantation, ESOT and 22nd Annual Conference of the British Society for His — Location: Glasgow, United Kingdom (4.September.2011)

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Background: Adult polycystic liver disease (PLD) is frequently associated with autosomal dominant polycystic kidney disease (ADPKD). Established indication for combined liver and kidney transplantation (CLKTx) is end stage renal failure. If renal insufficiency is less advanced, indications for combined kidney transplantation (KTx) are controversial. We reviewed our experience with isolated liver transplantation (LTx) and CLKTx in patients with PLD. Methods: Between 1995-2008, 56 patients originating from 2 collaborating centers underwent LTx for PLD. 7 patients with isolated PLD received LTx alone. Of 49 patients with combined PLD and ADPKD, 31 underwent isolated LTx and 18 CLKTx. Among the 18 CLKTx recipients, 11 were dialysisdependent pre-transplant whereas 7 had a creatinine clearance (CrCl) between 15 and 38 mL/min. Results: Median follow up is 34 months (range, 26-167). 1 and 5-year patient and liver graft survival were 96% and 94%, and 96% and 90%, respectively. The 1 and 5-year kidney graft survival (death censored) is 100%. Of the 31 patients who underwent isolated LTx for combined PLD and ADPKD, 29% (n=9) developed terminal renal failure post-LTx. Their mean pre-LTx CrCl was 76 mL/min (range, 48-110). The mean pre-LTx CrCl in the 71% patients who display stable kidney function post-LTx was 78 mL/min (range, 47-153). Pre-LTx CrCl was not a significant factor for the development of renal failure after isolated LTx for combined PLD and ADPKD (p=0,835). Conclusion: This series demonstrates that short- & long-term survival after LTx and CLKTx for PLD is excellent. In patients with clearly-proven & evolving renal impairment pre-transplant, CLKTx is the preferred option, anticipating the need for later KTx. In patients with preserved/mildly disturbed renal function, nephron sparing strategies are essential since evolution towards renal failure is seen in 29%, without clear prognosis factors.
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Darius, T., Patris, A., Hassoun, Z., Monbaliu, D., Ciccarelli, O., Ciccarelli, O., Pirson, Y., Vvanrenterghem, Y., Nevens, F., Lerut, J., & Lerut, J. (2011). Evolution of kidney function after liver transplantation for adult polycystic liver disease and indications for combined liver and kidney transplantation. Transplant international, 24(Suppl 2), 28. https://hdl.handle.net/2078.5/218201 (Original work published 2011)