Extreme living donation: A single center simultaneous and sequential living liver-kidney donor experience with long-term outcomes under literature review

Abstract

Objective: Living liver and kidney donor surgeries are major surgical procedures applied to healthy people with mortality and morbidity risks not providing any direct therapeutic advantage to the donor. In this study, we aimed to share our simultaneous and sequential living liver-kidney donor experience under literature review in this worldwide rare practice. Material and Methods: Between January 2007 and February 2018, a total of 1109 living donor nephrectomies and 867 living liver donor hepatectomies were performed with no mortality to living-related donors. Eight donors who were simultaneous or sequential living liver-kidney donors in this time period were retrospectively reviewed and presented with their minimum 2- year follow-up. Results: Of the 8 donors, 3 of them were simultaneous and 5 of them were sequential liver-kidney donation. All of them were close relatives. Mean age was 39 (26-61) years and mean BMI was 25.7 (17.7-40). In 3 donors, right lobe, in 4 donors, left lateral sector, and in 1 donor, left lobe hepatectomy were performed. Median hospital stay was 9 (7-13) days. Two donors experienced early and late postoperative complications (Grade 3b and Grade 1). No mortality and no other long-term complication occurred. Conclusion: Expansion of the donor pool by utilizing grafts from living donors is a globally-accepted proposition since it provides safety and successful outcomes. Simultaneous or sequential liver and kidney donation from the same donor seems to be a reasonable option for combined liver-kidney transplant recipients in special circumstances with acceptable outcomes.

Dual living donor organ transplants

“…The first simultaneous liver (lateral segments) and kidney procurement was performed in Turkey in 1992 12 . Also in Turkey, in 2001, a 20‐year‐old woman simultaneously donated the left liver lobe (segments 2–4) and the right kidney to her 9‐year‐old brother to treat primary hyperoxaluria type I 13–15 . Between 2000 and 2019, nine simultaneous LD liver‐kidney transplants in adult recipients were performed in South Korea 16 .…”

“…12 Also in Turkey, in 2001, a 20-year-old woman simultaneously donated the left liver lobe (segments 2-4) and the right kidney to her 9-year-old brother to treat primary hyperoxaluria type I. [13][14][15] Between 2000 and 2019, nine simultaneous LD liver-kidney transplants in adult recipients were performed in South Korea. 16 The first simultaneous LD right lobe liver and kidney transplant (father donating to son) was reported by Marujo et al in Brazil in 1999.…”

Combined liver‐kidney transplantation in pediatric patients

“…However, in Asian countries, organs are often obtained from two different donors, whether they are living or deceased, or a combination of the two. 90 In rare cases, a single living donor may donate both a partial liver and kidney to a single recipient, prioritizing the safety of the donor if they are the only available donor. In such situations, the well-being of the donor takes precedence over the potential benefits of smLKT for the recipient.…”

“…For CLKT, there may be a need for either one donor or two donors since two organs are required. 90,91 The very first CLKT living donation took place in Turkey in 1992, where a mother donated her left lateral section and right kidney to her daughter. 92 Although the donor had no complications, the recipient died 15 days after the smLKT.…”

“…A living donor hepatectomy and nephrectomy from a single donor is a major surgery, irrespective of whether the graft is a left lateral section or donor operation is sequential. For CLKT, there may be a need for either one donor or two donors since two organs are required 90,91 . The very first CLKT living donation took place in Turkey in 1992, where a mother donated her left lateral section and right kidney to her daughter 92 .…”