Combined liver-kidney transplantation in polycystic disease: Our experience and literature review

Table 1 Comparison of kidney implantation and preservation strategies reported in combined liver-kidney transplantation

Strategy/protocol	Kidney implantation timing and preservation	Main reported findings (qualitative)	Key limitations
Standard SLKT	Simultaneous/SCS	Widely used and feasible	Not specifically designed to protect kidney during immediate post-LT instability
		However renal graft may be exposed to unfavorable hemodynamics during/after LT	Heterogeneous outcomes depending on recipient severity
End-ischemic renal MP in marginal kidneys[40]	Simultaneous/end ischemic HOPE/NMP/HMP	Benefits not consistently demonstrated across studies, especially in marginal graft settings	Heterogeneous donor types/protocols/endpoints
		HMP associated with lower DGF in some analyses, despite longer CIT	Limited CLKT-specific evidence
		No clear effect on PNF
Delayed KT after LT with machine perfusion[46]	Delayed (timing variable)/HMP	Demonstrates technical feasibility and potential benefit in selected high-risk cases	Very small numbers
			Case-based evidence
			No standardized protocol
			Limited comparability across reports
Delayed KT after LT with HMP (“Indiana approach”)[43]	Continuous HMP during delay (typically 1-3 days after LT)	Reported improved renal outcomes (lower DGF/better eGFR) despite prolonged CIT in selected CLKT recipients	Primarily single-center experience
			Retrospective design
		Physiologically attractive strategy	Limited external validation

SLKT: Simultaneous liver-kidney transplantation; SCS: Static cold storage; KT: Kidney transplantation; LT: Liver transplantation; HOPE: Hypothermic oxygenated perfusion; NMP: Normothermic machine perfusion; HMP: Hypothermic machine perfusion; DGF: Delayed graft function; CIT: Cold ischemia time; PNF: Primary non-function; eGFR: Estimated glomerular filtration rate.

Table 2 Baseline and perioperative characteristics of 20 adult recipients undergoing combined liver-kidney transplantation, n (%)/median (interquartile range)

Variable	Value
Male sex	8 (40)
Recipient age	52.5 (48.0-58.5)
Model for end-stage liver disease	21.0 (16.8-23.2)
Serum creatinine at transplant, mg/dL	6.8 (3.7-8.0)
Hemodialysis at transplant	15 (75.0)
Machine-perfused liver graft	0 (0)
Machine-perfused kidney graft	4 (20)
Split liver	1 (5)
Post transplant outcomes
Dialisis at transplant	15 (75.0)
Delayed liver graft function	2 (10.0)
Delayed renal graft function	6 (30.0)
Occurrence of acute renal rejection	1 (5.0)

Table 3 Longitudinal observations of renal function and survival after combined liver-kidney transplantation, n (%)

	Time after combined liver-kidney transplant
	1 year	3 years	5 years
Patients in follow-up	16	11	11
Estimated glomerular filtration rate, mL/minute/1.73 m2
Median	64.0	62.0	64.0
IQR	53.8-73.5	44.5-69.0	43.5-73.5
eGFR ≥ 60	10 (62.5)	6 (55)	6 (55)
eGFR 30-59	6 (37.5)	5 (45)	4 (36)
eGFR < 30	0	0	1 (9)
Graft survival, KM-estimate (95%CI)	85% (71%-100%)	85% (71%-100%)	85% (71%-100%)
Overall survival, KM-estimate (95%CI)	95% (86%-100%)	95% (86%-100%)	95% (86%-100%)

IQR: Interquartile range; eGFR: Estimated glomerular filtration rate; KM: Kaplan-Meier; CI: Confidence interval.