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

Liver Int. 2016 Jul;36(7):1018-25. doi: 10.1111/liv.13041. Epub 2016 Jan 19.

Abstract

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.

Keywords: combined liver/kidney transplant; polycystic liver and kidney disease; transplant outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cysts / complications
  • Cysts / surgery*
  • Databases, Factual
  • Female
  • Humans
  • Kidney Transplantation*
  • Liver Diseases / complications
  • Liver Diseases / surgery*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Polycystic Kidney Diseases / complications
  • Polycystic Kidney Diseases / surgery*
  • Prognosis
  • Survival Analysis
  • United States / epidemiology

Supplementary concepts

  • Polycystic liver disease