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. 2021 Sep;406(6):2107-2115.
doi: 10.1007/s00423-021-02206-9. Epub 2021 May 26.

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

Philipp Felgendreff  1   2 , Hans-Michael Tautenhahn  3   4 , Sascha Lux  3 , Felix Dondorf  3 , René Aschenbach  5 , Falk Rauchfuss  3 , Utz Settmacher  3
Affiliations

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

Philipp Felgendreff et al. Langenbecks Arch Surg. 2021 Sep.

Abstract

Purpose: In patients suffering from autosomal dominant polycystic liver and kidney disease (ADPLKD), combined organ transplantation often poses a technical challenge due to the large volume of both organs. To simplify the transplantation procedure by improving the exposure of anatomical structures, we introduce a novel surgical technique of orthotopic liver and kidney transplantation.

Methods: The modified simultaneous liver and kidney transplantation technique via a right-sided L-incision included three steps: (1) right-sided nephrectomy in the recipient followed by (2) orthotopic liver transplantation in cava replacement technique and (3) the orthotopic kidney transplantation with arterial reconstruction to the right common iliac artery.

Results: In total, seven patients with ADPLKD were transplanted by using the modified transplantation technique. The mean operation time was 342.43 min (±68.77). Postoperative patients were treated for 6.28 days (±2.50) in the intensive care unit and were discharged from the surgical ward approximately 28 days (±5.66) after the operation with normal graft function. Complications associated with the use of the modified technique, such as bleeding, anastomotic stenosis, biloma, or urinoma, did not occur.

Conclusion: Modified simultaneous liver and kidney transplantation is a safe alternative for patients with ADPLKD. By combining right-sided nephrectomy and orthotopic graft transplantation, the approach optimizes the exposure of anatomical structures and simplifies the transplantation procedure. Additionally, the modified transplantation technique does not require a particular organ explantation procedure and can be applied for all liver and kidney grafts.

Keywords: Autosomal dominant polycystic liver and kidney disease; Kidney transplantation; Liver transplantation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CT reconstruction (MeVis® (Frauenhofer MeVis, Lübeck, Germany)) after transplantation in a patient with polycystic liver and kidney degeneration. A: Illustration of the venous vascular anatomy of the transplanted organs. B: Illustration of the arterial and portal venous anatomy of the transplanted organs
Fig. 2
Fig. 2
Coronal presentation of the portal vein in a polycystic liver. The kidneys are also polycystically degenerated as seen in the CT scan (CT Revolution 256 slice, GE Healthcare, USA) before transplantation
Fig. 3
Fig. 3
Coronal presentation of the caval region showing polycystic alterations in both kidneys on the CT scan (CT Revolution 256 slice, GE Healthcare, USA) before transplantation
See this image and copyright information in PMC

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