Abstract
Objective To report the clinical effectiveness and safety of combined kidney transplantation and splenic fossa auxiliary heterotopic liver transplantation for highly sensitized recipients with uremia. Methods In March 2014, combined kidney transplantation and splenic fossa auxiliary heterotopic liver transplantation from the same donor was performed in a highly sensitized recipient with positive panel reactive antibodies (PRA) (31% class Ⅰ, 63% class Ⅱ). Compendious technical scheme: the partial liver from the same donor was transplanted in splenic recess of the recipient before the renal transplantation operation. Hyperacute rejection and the function of kidney after the transplantation were observed. Serum samples were also collected before and after reperfusion of the liver and each time points after the transplant surgery to detect the antibody level. Results The operation took 8 hours and 25 minutes with bleeding of 700 ml. The renal transplant functioned well without hyperacute rejection after transplantation. All the human leukocyte antigen antibodies turned to negative at 3 hour post-transplantation. The concentration of serum creatinine was 141 μmol/L and the level of PRA was 80% at 6 day post-transplantation. At 7 day post-transplantation, the creatinine level increased and acute rejection of transplant kidney occurred, which was controlled by plasmapheresis, anti-thymocyte globulin and intravenous immunoglobulin. The recipient was followed up for 12 months, serum creatinine value was 131 μmol/L. Conclusions A simultaneous transplantation of a partial auxiliary liver graft from the same donor in splenic fossa, with the sole purpose of protecting the kidney from harmful lymphocytotoxic antibodies, may solve the problem of kidney transplantation in highly sensitized recipients. Key words: Highly sensitization; Kidney transplantation; Combined transplantation; Splenic fossa auxiliary heterotopic liver transplantation; Hyperacute rejection
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