A 62-year-old man presented with complaints of abdominal pain for ~1 week. Further evaluation by computed tomography (CT) demonstrated a large, polycystic kidney located in the left pelvis (Figure 1).
Figure 1 |.
Computed tomography imaging of a deceased donor polycystic kidney transplant in 2012 showing a large kidney with many cysts.
His medical history was significant for diet-controlled diabetes, hepatitis C, and stage 4 chronic kidney disease with a baseline serum creatinine of 2–2.5 mg/dl. The patient had a deceased donor kidney transplant in 1985. His immunosuppressive regimen was 150 mg azathioprine daily, 50 mg cyclosporine daily, and 10 mg prednisone daily. Physical examination was remarkable for right upper quadrant tenderness. Urinalysis was notable for proteinuria (5g/day) and isomorphic hematuria.
CT imaging from 2006 also demonstrated a polycystic kidney, albeit of smaller size and with fewer, smaller cysts. Clearly, progression of kidney and cyst size occurred from 2006 to 2012. The dimensions of the largest cysts expanded from 3.4×3 cm2 in 2006 (Figure 2) to 4.7×4.2 cm2 in 2012 (Figure 1). Previous CT and ultrasound studies were not available, but radiology reports support the progression of cystic kidney disease in this transplanted kidney. This suggests that the patient received a deceased donor from a patient with undiagnosed autosomal dominant polycystic kidney disease.
Figure 2 |.
Computed tomography imaging of a deceased donor polycystic kidney transplant in 2006 showing a smaller kidney with fewer cysts of smaller size.
Cases of donated polycystic kidneys have been reported. However, this case represents 27 years of a functioning deceased donor polycystic kidney transplant, the longest reported. The literature supports the contention that polycystic kidney grafts after transplant have a reasonable survival and suggest that they are suitable alternatives for organ donation. In view of the current shortage of kidneys, it remains to be seen whether transplantation of polycystic kidneys will become an evidence-supported practice.