Liver Transplantation for Polycystic Liver Disease: A 20-Year Experience
Surgery, University of California, Los Angeles, CA
Meeting: 2013 American Transplant Congress
Abstract number: A625
Introduction: Polycystic liver disease (PCLD) can lead to massive, highly symptomatic hepatomegaly and a reduced quality of life. While hepatic resection and cyst fenestration can be used selectively for palliation of patients with well-preserved hepatic and renal function, liver transplantation (LT) has been proposed as primary therapy for patients with bilobar disease, malnutrition, and concomitant renal dysfunction.
Objective: To report our institutional experience of LT for PCLD and identify predictors of outcome.
Setting: Large university medical center, October 1992 through August 2012
Patients: 27 patients with PCLD underwent LT; 25 (93%) had polycystic kidneys (PCLKD), and 11(41%) underwent concomitant kidney transplantation. Mean age was 50 (range 13-64) years, and 81% were female. 17 patients had prior disease-directed surgical therapy including liver cyst fenestration (10), liver resection (3), nephrectomy (9), and kidney transplantation (6). Indications for LT included chronic abdominal pain (96%), early satiety (52%), renal failure (41%), dyspnea (37%), and ascites (30%). Mean follow-up was 64 months.
Results: Overall survival after LT was 81%. Comparing patients with and without prior surgery, the former group had significantly greater length of stay, lower overall survival, and a trend to more post-transplant reoperations, as shown:
Prior Surgery (n=17) | No Prior Surgery (n=10) | P-value | |
---|---|---|---|
No. of operations (per patient) | 28 (1.6) | – | |
Pre-operative albumin (g/dL) | 3.7 | 3.5 | 0.46 |
Explant liver weight (kg) | 5.4 | 6.0 | 0.59 |
Liver-kidney transplant (%) | 47 | 30 | 0.40 |
Operative blood loss (uPRBC) | 14 | 10 | 0.33 |
Length of stay (days) | 25 | 16 | 0.04 |
Alive at last follow up (%) | 12 (71) | 10 (100) | 0.02 |
Reoperations, n (%) | 5 (24) | 1 (10) | 0.28 |
In the sub-group of patients with prior surgery, patients who died (n=5) had more than twice the number of pre-transplant operations (3.0 vs 1.3; P=0.03) and were the only patients to require reoperation (80% vs 0%; P=0.02), compared to the long-term survivors (n=12).
Conclusions: This is one of the largest series of LT for PCLD/PCKLD. Although long-term survival is excellent, prior palliative surgical therapy significantly increases the risk for post-transplant morbidity and mortality and should be avoided in patients best treated with LT.
To cite this abstract in AMA style:
Baber J, Agopian V, Hiatt J, Busuttil R. Liver Transplantation for Polycystic Liver Disease: A 20-Year Experience [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/liver-transplantation-for-polycystic-liver-disease-a-20-year-experience/. Accessed December 12, 2024.« Back to 2013 American Transplant Congress