Same Donor Laparoscopic Liver and Kidney Procurement for Sequential Living Donor Liver–Kidney Transplantation in Primary Hyperoxaluria Type I

Abstract

Background: Sequential liver-kidney transplantation (SeqLKT) from the same living donor has shown excellent results in children with primary hyperoxaluria type 1 (PH1), yet its experience is limited due to the invasiveness of two major procedures for liver-kidney procurement in a single donor. Despite laparoscopic nephrectomy and hepatic left lateral sectionectomy (LLS) being considered standard procedures in living donation, the sequential use of the two laparoscopic approaches in the same living donor has never been reported. Methods: Herein, we present the first two case series of laparoscopic liver-kidney procurement in the same living donor for SeqLKT in children with PH1 and review of the current literature on this topic. Results: In the first case, a 15-month-old boy received a SeqLKT from his 32-year-old mother, who underwent a laparoscopic LLS and, after 8 months, a laparoscopic left nephrectomy. In the second case, a 34-month-old boy received a SeqLKT from his 40-year-old father who underwent laparoscopic LLS followed by handassisted right nephrectomy after 4 months. Both donors had uneventful postoperative courses and were discharged within 5 days from each surgery. The first recipient had no complication; the second child after liver transplantation developed a partial thrombosis of the inferior vena cava, which did not preclude the sequential kidney transplantation. After 12 months, donors and recipients displayed normal liver and renal functions. Conclusions: Sequential laparoscopic liver-kidney procurement in the same living donor is safe and feasible, and might be considered as a possible strategy to promote SeqLKT in children with PH1 from the same living donor.

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

“…On the other hand, it might be the only chance for a recipient in a region with insufficient deceased donor support. In addition, most of the reports focus on recipient outcomes, and most of the recipients are pediatric primary hyperoxaluria type 1 patients (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). No donor mortality and no life-treating complications were reported in these cases and case series.…”

“…Minimizing incision is an alternative, which has been reported in the literature with same outcomes (33,34). In the last two decades, pure laparoscopic or laparoscopic hand assistant donor nephrectomy has been established as the gold standard (28). Beginning with donor left lateral sector hepatectomy in 2002 by Cherqui et al (35), laparoscopic and other minimally invasive approaches are being used today for living liver donation.…”

Combined liver kidney transplantation for primary hyperoxaluria type 1: Will there still be a future? Current transplantation strategies and monocentric experience

“…Sequential transplantation may be considered in infants with residual renal function to reduce the risk of kidney graft loss, and living donor liver transplantation, followed by a deceased donor kidney transplantation, probably represents the best option for the logistic and timing issues. 24 Choosing the best transplant strategy to be adopted is always bound to be a challenge and will ultimately be decided on a case-bycase basis, depending on PH1 genotype, clinical phenotype, stage of the disease, age and size of the child, and on the center experience.…”

“…In our experience, CLKT remains the first choice in children older than 2 year, and we consider this option safe and feasible 16 Monitoring of the plasma oxalate levels before and after transplantation can provide useful information on the best strategy to be pursued for management of CLKT in PH1. Sequential transplantation may be considered in infants with residual renal function to reduce the risk of kidney graft loss, and living donor liver transplantation, followed by a deceased donor kidney transplantation, probably represents the best option for the logistic and timing issues 24 …”

Laparoscopic isolated caudate lobectomy of two symptomatic familiar giant liver hemangiomas, case reports and literature review

“…In fact, according to The First International Consensus Conference on Laparoscopic Liver Surgery held in Louisville in 2008, "difficult" resections with lesions located in posterior-superior segments (sI-VII-VIII) were included in major resections and were not universally accepted as standard of care [24]. However, in some very experienced liver units, even these lesions in selected patients can be addressed laparoscopically [25,26].…”