First successful case of simultaneous liver and kidney transplantation for patients with chronic liver and renal failure in Japan

Abstract

Establishment of a preferential liver allocation rule for simultaneous liver and kidney transplantation (SLK) and revisions of laws regarding organ transplants from deceased donors have paved the way for SLK in Japan. Very few cases of SLK have been attempted in Japan, and no such recipients have survived for longer than 40 days. The present report describes a case of a 50-year-old woman who had undergone living donor liver transplantation at the age of 38 years for management of post-partum liver failure. After the first transplant surgery, she developed hepatic vein stenosis and severe hypersplenism requiring splenectomy. She was then initiated on hemodialysis (HD) due to the deterioration of renal function after insertion of a hepatic vein stent. She was listed as a candidate for SLK in 2011 because she required frequent plasma exchange for hepatic coma. When her Model for End-stage Liver Disease score reached 46, the new liver was donated 46 days after registration. The reduced trisegment liver and the kidney grafts were simultaneously transplanted under veno-venous bypass and intraoperative HD. The hepatic artery was reconstructed prior to portal reconstruction in order to shorten anhepatic time. Although she developed subcapsular bleeding caused by hepatic contusion on the next day, subsequent hemostasis was obtained by transcatheter embolization. Thereafter, her recovery was uneventful, except for mild rejection and renal tubular acidosis of the kidney graft. This case highlights the need to establish Japanese criteria for SLK.

Liver alone or simultaneous liver-kidney transplant? Pretransplant chronic kidney disease and post-transplant outcome - a retrospective study

“…In addition, because SLK practice varies worldwide, the results of our study would be helpful for centers in other countries to consider expansion of SLK criteria. The new UNOS SLK policy contains more aggressive indication criteria than other countries’ or regions’ policies . To confirm the validity and applicability of the new UNOS SLK policy, additional national or international surveys and/or multisite studies are needed .…”

Current treatment status of polycystic liver disease in Japan

“…In the present study, there was no case that underwent SLK for PKD. Additionally, the first case of successful SLK was reported in 2013 in Japan . In the current Japanese status, it is difficult to perform SLK even with renal failure, because most transplantation cases are dependent on a living donor.…”

“…Additionally, the first case of successful SLK was reported in 2013 in Japan. 33 In the current Japanese status, it is difficult to perform SLK even with renal failure, because most transplantation cases are dependent on a living donor. On the other hand, Simpson et al reported that SLK has an immunological advantage over serial transplantation in terms of avoiding the risk of pre-sensitization, when recipients require liver and kidney transplantation.…”

A successful case of deceased donor liver transplantation for a patient with intrahepatic arterioportal fistula

“…The recipient surgery included conventional orthotopic liver transplantation with the removal of the native liver with the retrohepatic inferior vena cava. Both the left axillary and the right saphenous veins were exposed for veno‐venous bypass during the anhepatic phase . Explantation of the native liver began with the division of the hepatic hilum, especially division of the distended hepatic artery that was hemorrhagic due to portal hypertension.…”

“…Both the left axillary and the right saphenous veins were exposed for veno-venous bypass during the anhepatic phase. 17 Explantation of the native liver began with the division of the hepatic hilum, especially division of the distended hepatic artery that was hemorrhagic due to portal hypertension. After dissection of the hepatic artery and the common bile duct, the left and right lobes were dissected from the surrounding adhesion, which was also hemorrhagic.…”