Abstract: PUB229
Liver Transplantation for Polycystic Liver Disease: Mayo Clinic Three-Site Experience
Session Information
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Kamalumpundi, Vijayvardhan, Mayo Clinic Division of General Internal Medicine, Rochester, Minnesota, United States
- Alhazaimeh, Mohammad A. K., Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States
- Howe, Cassie, Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States
- Smith, Byron H., Mayo Clinic Division of Clinical Trials and Biostatistics, Rochester, Minnesota, United States
- Gregory, Adriana, Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States
- Zoghby, Ziad, Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States
- Kline, Timothy L., Mayo Clinic Division of Clinical Trials and Biostatistics, Rochester, Minnesota, United States
- Kamath, Patrick S., Mayo Clinic Division of Gastroenterology and Hepatology, Rochester, Minnesota, United States
- Olson, Jody C., Mayo Clinic Division of Gastroenterology and Hepatology, Rochester, Minnesota, United States
- Heimbach, Julie, Division of Transplantation Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Mathur, Amit K., Division of Transplantation Surgery, Mayo Clinic, Phoenix, Arizona, United States
- Lizaola-Mayo, Blanca, Mayo Clinic Minnesota Division of Gastroenterology and Hepatology, Phoenix, Arizona, United States
- Hogan, Marie C., Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States
Background
Liver transplantation (LT) is the definitive therapy for severely symptomatic polycystic liver disease (PLD) due to autosomal dominant polycystic kidney disease (ADPKD) & autosomal dominant polycystic liver disease (ADPLD). Multicenter outcome data remain limited. We evaluated the Mayo Clinic experience with LT for PLD.
Methods
Retrospective multicenter cohort of LT patients (Mayo LT Database) at Mayo Clinic transplant centers in Minnesota, Florida, and Arizona from Jan 1989-July 2025. Demographic, imaging, and longitudinal follow-up were analyzed. Model for End-Stage Liver Disease (MELD) scores (mean ± SD) were stratified before & after implementation of the National Liver Review Board (NLRB) framework on 5/1/2019.
Results
Among 11,410 LT recipients, 129 (1.13%) underwent LT for PLD. The cohort was predominantly female (70%), White (75%), with a median transplant age 63 years. The primary indication for LT was severe symptoms despite aspiration/fenestration of hepatic cysts, hepatic resection or when such procedures were not feasible, portal hypertension, and sarcopenia. Median waitlist time was 82.5 days (IQR 179). Overall, 117 patients had ADPKD (90.6%), and 12 had ADPLD (9.3%). Seventy-five (53.9%) underwent combined liver-kidney transplantation, 30 underwent isolated LT, and 24 underwent kidney transplant before (n=15) or after LT (n=9). Mean liver volume (LV) at transplant was 7,896±3,822 mL. Annual pre-transplant liver growth was 405.7mL/year (95% CI 238.3 - 573.2), corresponding to 6.0% annual growth (95% CI 4.6%-7.5%). Mean biologic MELD scores were lower in the post-NLRB era compared with the pre-NLRB era (16±5.2 vs 18±9.3), whereas the mean MELD for other LT indications was 20.3±9.6. Three-year post-transplant survival was 90%, with similar outcomes between sexes. LT frequency for PLD peaked in 2019.
Conclusion
The Mayo liver transplant program data is one of the largest multicenter cohorts of LT for PLD.This study is one of the first to characterize LV progression before transplantation. Patients had progressive hepatomegaly prior to LT, with annual liver growth exceeding 400mL, reflecting a symptomatic disease burden inadequately captured by physiologic MELD scoring alone. Despite relatively low MELD scores, LT was associated with excellent 3-year survival. These findings support the impact of MELD exception pathways to ensure equitable transplant access for patients with advanced PLD.