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. 2018:53:13-16.
doi: 10.1016/j.ijscr.2018.10.002. Epub 2018 Oct 8.

En bloc liver-kidney transplantation with renal artery variation using donor splenic artery and left gastric artery as inflow to the kidney: Case report

Michelle C Nguyen  1 , Sylvester Black  1 , Ken Washburn  1 , Ashraf El-Hinnawi  2
Affiliations

En bloc liver-kidney transplantation with renal artery variation using donor splenic artery and left gastric artery as inflow to the kidney: Case report

Michelle C Nguyen et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: En bloc liver-kidney transplantation can be difficult with renal artery variations for which the risk of multiple anastomoses can outweigh the benefits.

Presentation of case: This report is the first to describe an en bloc liver-kidney transplantation using a donor kidney with double renal arteries. The indication for a combined liver-kidney transplant was non-alcoholic steatohepatitis (NASH) cirrhosis with chronic kidney disease secondary to hypertension and diabetes compounded by hepato-renal syndrome. The explant pathology was consistent with steatohepatitis, but did have PAS/D-positive intracytoplastic globules which suggest an additional component of alpha-1-antitrypsin deficiency.

Discussion: Diminished arterial inflow to the inferior renal pole was noted intraoperatively, requiring re-anastomosis of the inferior renal polar artery to the donor left gastric artery. The post-operative course was uncomplicated with patient discharge on post-operative day six.

Conclusion: With increasing numbers of simultaneous liver-kidney transplants being performed, kidneys with multiple renal arteries can successfully be transplanted en-bloc without compromising ischemia time.

Keywords: En bloc liver-kidney transplantation; Renal artery variation; Simultaneous liver-kidney transplantation.

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Figures

Fig. 1
Fig. 1
Back-table reconstruction with arterioplasty of hilar renal artery and inferior renal polar artery followed by end to end renal artery anastomosis to donor splenic artery. A: Anatomical view. B: Posterior view. a; artery, aa; arteries, v; vein.
Fig. 2
Fig. 2
En bloc liver-kidney transplant: vascular, biliary and ureter anastomosis.
See this image and copyright information in PMC

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