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Kidney Week

Abstract: PO2163

A Rare Case of Liver Failure in a Kidney Transplant Recipient with Polycystic Kidney Disease

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Lakhani, Laila S., Emory University School of Medicine, Atlanta, Georgia, United States
  • Vasanth, Payaswini, Emory University School of Medicine, Atlanta, Georgia, United States
Introduction

Autosomal dominant polycystic kidney disease (ADPKD) patients usually have great outcomes post kidney transplant. We describe a rare case (none reported in literature), where kidney transplantation led to progressive enlargement of liver cysts and liver failure physiology.

Case Description

A 51 year old female with end-stage kidney disease from ADPKD, underwent a deceased donor kidney transplant in July 2020. She was induced with basiliximab and maintained on Belatacept, Tacrolimus, mycophenolate and prednisone, with a baseline creatinine of 1 mg/dL. In October 2020, she presented with gross anasarca when CT imaging revealed large ascites, worsening of liver cyst burden, splenic enlargement and IVC compression. Ascitic fluid analysis indicated portal hypertension. Trans-jugular liver biopsy demonstrated nodular regenerative hyperplasia and vascular flow abnormality. MR Venogram showed severe narrowing of the IVC, hepatic and portal veins from mass effect of liver cysts. She underwent IVC stent placement; however, post procedure course was complicated by klebsiella bacteremia, that progressed to developing septic lung emboli and anuric acute kidney injury. She developed multi-organ failure requiring vasopressors, intubation, renal replacement therapy and worsening hepatic encephalopathy. This complex hospitalization culminated into her demise secondary to cardiac arrest.

Discussion

This is a very challenging yet fascinating case that highlights progressive liver failure from rapidly enlarging liver cysts within 3 months of kidney transplantation. Did immunosuppression contribute to accelerating the growth of liver cysts? Should a select group of patients with ADPKD be evaluated for combined liver and kidney transplant? Multi-disciplinary discussions between transplant nephrology and hepatology can guide decision making in these complex patients.