Pure living donor liver transplant for liver and polycystic kidney disease, outcomes and experiences from an Asian transplant unit

• This study presents one of the largest single-center case series of isolated LDLT for PLD associated with polycystic kidney disease (PCKD). • LDLT offers excellent long-term survival (5-year survival of 88.9 %) with acceptable perioperative morbidity in patients with PLD. • Pre-existing chronic kidney disease (CKD) was associated with early post-transplant renal deterioration and need for renal replacement therapy (RRT). • No major complications or mortality were observed among living liver donors, supporting the safety of LDLT in this context. • The study highlights the importance of tailored surgical strategies, including caval reconstruction, in managing massive polycystic livers. Adult polycystic liver disease (PLD) is a rare genetic disorder. In instances of intractable symptoms from mass effect or recurrent cyst-related complications, liver transplant affords the best therapeutic solution. This is a retrospective case series of patients who underwent isolated pure living donor liver transplantation (LDLT) for adult polycystic kidney disease (PCKD) associated PLD from 2012- 2022. Short-term peri‑operative outcomes including renal sequelae and long-term survival were analysed. From 2012–2022, a total of 9 patients underwent LDLT for PLD. The median explanted liver weight was 6950 g (IQR 5653–7700) with a median blood loss of was 5450mls (IQR 2400–9875). There was 1 mortality due to acute antibody-mediated rejection (11.1 %). Of the four patients with existing chronic kidney disease (CKD), 2 (50 %) developed end-stage renal failure and was renal replacement therapy (RRT) dependent at 3 months. The median overall survival in our series was 63.9 months with a 5-year survival of 88.9 %. Despite its technical challenges, LDLT affords an excellent long-term prognosis with acceptable major morbidity. Pre-operative CKD appears to be a risk factor for early renal deterioration.