Outcomes of en bloc simultaneous liver-kidney transplantation compared to the traditional technique

Abstract

Simultaneous liver‐kidney transplantation (SLKT) is indicated for patients with end‐stage liver disease (ESLD) and concurrent renal insufficiency. En bloc SLKT is an alternative to traditional separate implantations, but studies comparing the two techniques are limited. The en bloc technique maintains renal outflow via donor infrahepatic vena cava and inflow via anastomosis of donor renal artery to donor splenic artery. Comparison of recipients of en bloc (n = 17) vs traditional (n = 17) SLKT between 2013 and 2017 was performed. Recipient demographics and comorbidities were similar. More recipients of traditional SLKT were dialysis dependent (82.4% vs 41.2%, P = .01) with lower baseline pretransplant eGFR (14 vs 18, P = .01). En bloc SLKT was associated with shorter kidney cold ischemia time (341 vs 533 minutes, P < .01) and operative time (374 vs 511 minutes, P < .01). Two en bloc patients underwent reoperation for kidney allograft inflow issues due to kinking and renal steal. Early kidney allograft dysfunction (23.5% in both groups), 1‐year kidney graft survival (88.2% vs 82.4%, P = 1.0), and posttransplantation eGFR were similar between groups. In our experience, the en bloc SLKT technique is safe and feasible, with comparable outcomes to the traditional method.

Simultaneous right-sided nephrectomy with orthotopic liver and kidney transplantation—An alternative method for patients with autosomal dominant polycystic liver and kidney disease

“…Using this method, we are able to improve the transplantation procedure of patients with ADPLKD compared to the standard clinical procedure. Our alternative surgical approach represents the further development of other innovative approaches, as recently published by Jochmans et al [20] and Lee et al [21].…”

“…Additionally, the vascular structures are openly accessible and can be prepared for subsequent kidney transplantation. The second alternative transplantation method published by Lee et al is indicated for patients with extensive iliac artery disease and is performed as en bloc simultaneous liver-kidney transplantation [21]. In this approach, the liver and right kidney are explanted en bloc and remain attached via the venous structures in the course of the implantation procedure.…”

“…To reestablish arterial blood flow, extensive back-table preparation with reanastomosis of the renal and splenic arteries is essential. For this reason, Lee et al defined a contraindication for this technique in kidney grafts with multiple renal arteries [21]. Besides, the group described a steal phenomenon and kinking of the renal artery in two patients, making major revision operations and renewed arterial anastomosis necessary.…”

“…Another disadvantage is the particular explantation procedure that enables the en bloc transplantation technique [21]. The method can only be conducted if the venous structures between the liver and right kidney transplant are maintained during the donor operation.…”

“…Besides the unique explantation technique and specific donor characteristics, further aspects need to be considered when comparing the method of Lee et al [21] with our approach. Both methods require extensive preparation of the vascular structures.…”