Combined liver-kidney transplantation in polycystic disease: Our experience and literature review

Table 1 Comparison of kidney implantation and preservation strategies reported in combined liver-kidney transplantation

Strategy/protocol	Kidney implantation timing and preservation	Main reported findings (qualitative)	Key limitations
Standard SLKT	Simultaneous/SCS	Widely used and feasible	Not specifically designed to protect kidney during immediate post-LT instability
		However renal graft may be exposed to unfavorable hemodynamics during/after LT	Heterogeneous outcomes depending on recipient severity
End-ischemic renal MP in marginal kidneys[40]	Simultaneous/end ischemic HOPE/NMP/HMP	Benefits not consistently demonstrated across studies, especially in marginal graft settings	Heterogeneous donor types/protocols/endpoints
		HMP associated with lower DGF in some analyses, despite longer CIT	Limited CLKT-specific evidence
		No clear effect on PNF
Delayed KT after LT with machine perfusion[46]	Delayed (timing variable)/HMP	Demonstrates technical feasibility and potential benefit in selected high-risk cases	Very small numbers
			Case-based evidence
			No standardized protocol
			Limited comparability across reports
Delayed KT after LT with HMP (“Indiana approach”)[43]	Continuous HMP during delay (typically 1-3 days after LT)	Reported improved renal outcomes (lower DGF/better eGFR) despite prolonged CIT in selected CLKT recipients	Primarily single-center experience
			Retrospective design
		Physiologically attractive strategy	Limited external validation

SLKT: Simultaneous liver-kidney transplantation; SCS: Static cold storage; KT: Kidney transplantation; LT: Liver transplantation; HOPE: Hypothermic oxygenated perfusion; NMP: Normothermic machine perfusion; HMP: Hypothermic machine perfusion; DGF: Delayed graft function; CIT: Cold ischemia time; PNF: Primary non-function; eGFR: Estimated glomerular filtration rate.