Kidney Transplantation in Autosomal Dominant Polycystic Kidney Disease: Long- Term Imaging and Clinical Outcomes

Background: Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a leading cause of end-stage renal disease. Kidney transplantation restores renal function, but recipients remain at risk for cyst persistence, metabolic and cardiovascular (CV) complications, and malignancy. We evaluated long-term cyst behavior, complications, and survival in a Latin American cohort of ADPKD recipients. Methods: We retrospectively analyzed 72 adults transplanted between 1985 and 2024 at a tertiary referral center. Height-adjusted total kidney volume (Ht-TKV) was quantified on CT at ~1 year post-transplant by an experienced radiologist. Secondary outcomes included liver cyst change, new-onset diabetes after transplantation (NODAT), metabolic and CV complications, infections, neoplasms, and patient/graft survival. Multivariable logistic regression adjusted for age, sex, donor type, dialysis duration, and immunosuppression. Results: Median Ht-TKV decreased by 61% at 1 year (n=45). NODAT occurred in 23.8%, other metabolic complications in 38.9%, CV events in 20.8%, and infections in 65.3%. Neoplasms developed in 31.9% of patients, most frequently non-melanoma skin cancers. Median graft survival was 124.6 months; overall mortality was 18.1%. In multivariable models, male sex (OR 27.5, 95% CI 1.9–403.5) and shorter dialysis duration (OR 0.93 per month, 95% CI 0.88–0.99) predicted NODAT, whereas male sex (OR 10.2, 95% CI 1.5–70.6) and longer dialysis duration (OR 1.03 per month, 95% CI 1.00–1.05) were associated with CV events. Conclusions: Kidney transplantation in ADPKD results in substantial regression of native kidney cysts and excellent long-term survival. Nonetheless, metabolic, CV, infectious, and oncologic complications remain highly prevalent. This large Latin American cohort with extended imaging and clinical follow-up underscores the need for systematic monitoring and sex-specific risk stratification.