Hepatic cysts are one of several extrarenal manifestations of the ADPKD gene. Several factors, including age, gender, pregnancy, the degree of renal cystic disease, and the extent of renal functional impairment, may modify the expression of hepatic cystic disease. With advances in medical care, such as improvement in the management of end-stage renal disease, hemodialysis, and renal transplantation, patients with ADPKD will experience an increased life expectancy. As a result, complications associated with hepatic cysts may become more common, and physicians may encounter an increasing number of patients with ADPKD who have infected hepatic cysts. Several issues in the management of this complication remain unresolved, but the article by Telenti and associates in this issue of the Proceedings addresses some of the critical issues that physicians who are responsible for the care of these patients will certainly confront in future years.