Renal transplantation in patients with polycystic kidney disease: A single-center experience

During the 25-year period from 1963 to 1988, 127 patients with end-stage renal failure (ESRF) secondary to autosomal dominant polycystic kidney disease (ADPKD) received a total of 143 renal transplants. The average follow-up time was 116 months (range 3 to 300 months). Mean age (45.8 yr) was significantly higher than the average age in our transplant population (31 yr) (p < 0.001). No correlation was found between ADPKD and HLA-A or -B antigen frequency among the patients. Overall patient and graft survival was 90% and 73% at 1 yr, 74% and 53% at 5 yr, 55% and 36% at 10 yr, and 37% and 28% at 15 yr, respectively. When death with a functioning graft was excluded as a cause of graft loss, 15-yr graft survival was 57%. The most common causes of death were cardiovascular complications (46%) and infections (34%), while graft loss was mainly due to patient death (50%), or rejection (38%). Multivariable analysis showed patient survival to be influenced by the level of panel reacting antibodies at the time of transplantation (PRA) (p = 0.002), while graft survival was affected primarily by the donor status (living related vs. cadaver) (p = 0.02). Outcome in transplant patients with ADPKD was compared to outcome in two matched control groups: diabetic and nondiabetic transplant recipients. There was a lower patient survival rate for the diabetic group (p = 0.0003). Graft survival, however, was similar among the three groups, with the exception of diabetics treated with azathioprine, ALG and prednisone who appeared to have a lower graft survival rate (p = 0.0002). The cause of patient death and graft loss overall did not differ among the three groups studied; however, ADPKD and diabetic patients showed an increased death rate due to cardiovascular episodes for the time period between the 1st and 5th posttransplant years (p = 0.02). We conclude that, although ADPKD patients are older at the time of transplantation, they are excellent transplant candidates.