Living donor kidney transplantation after living donor liver transplantation from the same donor in a patient with autosomal dominant polycystic kidney disease: a case report.

Sequential living donor liver transplantation (LDLT) and living donor kidney transplantation (LDKT) from the same donor are extremely rare, with fewer than 10 such cases reported worldwide. These procedures present unique surgical, ethical, and immunological considerations. A 63-year-old man with autosomal dominant polycystic kidney disease (ADPKD) underwent LDLT from his wife for massive polycystic liver disease complicated by portal hypertension. Three years later, he received LDKT from the same donor following comprehensive evaluation for end-stage renal disease due to ADPKD. Pre-implantation kidney biopsy of the donor revealed thin basement membrane nephropathy with mild arteriosclerosis but preserved glomeruli. The postoperative course was uneventful, with immediate graft function and stable liver and kidney function at the six-month follow-up after kidney transplantation. This case demonstrates the feasibility of sequential living donor liver and kidney transplantation from a single donor in an exceptionally selected clinical setting; however, definitive conclusions regarding immune tolerance cannot be drawn from a single case, and careful donor selection, rigorous ethical safeguards, and long-term donor follow-up are essential.