*Purpose: Autosomal Dominant Polycystic Kidney Disease (ADPKD) patients are not routinely considered as kidney donors for renal transplantation. This is partially due to a concern that peri-transplant acute kidney injury (AKI) may accelerate cystogenesis in these kidneys similarly as it accelerates cystogenesis in animal ADPKD models. However, the immunosuppression may have cystogenesis-inhibiting effects, as seen in animal ADPKD models. Thus, minimally cystic kidneys from an ADPKD deceased donor have been rarely used as renal transplant allografts. The goal of this study was to quantify effects of transplantation on cystogenesis in kidneys from a donor with ADPKD.

*Methods: Two kidneys from a deceased ADPKD class 1A donor were transplanted into two individuals and MRI imaging was performed 1 month, 6 months, and 18 months post transplantation. ImageJ and LabVIEW based software tools were developed and used to measure and compare total kidney volumes (TKV) and individual cyst volumes at each time-point. This information was used to estimate the ADPKD classification for each recipient at individual time-points.

*Results: At 18 months post-transplant with ADPKD kidneys, TKV increased by 6.45% in recipient 1 and 38.85% in recipient 2 (annual TKV increase of 0.745% and 21.45%). Cyst numbers increased in recipient 1 from 20 (1 month) to 32 (18 months) and in recipient 2, cyst number increased from 10 to 22 during the same time period. Of the 21 individual cysts tracked in recipient 1, 12 increased and 9 decreased in volume. Of the 2 individual cysts tracked in recipient 2, 1 increased and 1 decreased in volume. At 18 months, recipient 1 had a serum creatinine 1.4 mg/dl (GFR: 52 ml/min/1.73m²), and recipient 2 had a serum creatinine 1.5 mg/dl (GFR: 43 ml/min/1.73m²). The ADPKD classification of each kidney at each time point was estimated using the Imaging Classification of ADPKD. Using the height adjusted total kidney volume and age of the kidneys, the classification was estimated and compared. For each recipient, there was a shift in the ADPKD classification to a more severe class. In the first recipient, there was a shift in classification from 1A to 1B and in the second recipient, from 1A to 1C.

*Conclusions: These data suggest that ADPKD kidneys from mildly affected ADPKD deceased donors may be used as marginal renal allografts in kidney transplantation and the cystogenic responses in transplanted ADPKD kidney allografts may differ between recipients.

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