Kirchner and colleagues looked at the outcome of 21 liver-only and 15 liver–kidney transplantation procedures (in 36 patients; 32 were female), performed at a single center in 1990–2003. Clinical outcomes were measured, and two post-transplantation questionnaires to evaluate quality-of-life and social parameters were completed: a self-designed questionnaire, and the Short Form 36 (SF-36; participants’ SF-36 scores were compared with those of agematched controls from the general population). Five patients (14%) died within 2 months of surgery; mean follow-up for the surviving patients was 62 ± 48 months. Of the 23 patients who completed questionnaires, over 90% reported feeling ‘better’ or ‘much better’ after transplantation, and nearly 80% said they would choose transplantation again. Apart from their power of concentration, all symptoms improved markedly after transplantation, including interest in sex, physical fitness, and appetite. SF-36 scores did not differ significantly between patients and controls. The authors conclude that liver or liver– kidney transplantation can improve the quality of life of patients with polycystic liver disease, and suggest that early surgery be considered for patients at a high risk of perioperative complications (i.e. those with severe cachexia or cyst infections).