Abstract
PurposeIn 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.MethodsThe 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.ResultsIn 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.ConclusionModified 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.
Highlights
Since first reported by Margreiter et al in 1984 [1], the simultaneous transplantation of the liver and kidney has beenDepartment of General, Visceral and Vascular Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, GermanyResearch Programme “Else Kröner-Forschungskolleg AntiAge”, University Hospital Jena, Am Klinikum 1, 07747 Jena, GermanyDepartment of Radiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany accepted as an effective surgical method in clinical practice, with good patient outcomes [2] and significant improvements in quality of life [3].One indication for simultaneous organ transplantation is autosomal dominant polycystic liver and kidney disease (ADPLKD) (Potter III)
We present a new modified surgical technique for orthotopic simultaneous liver and kidney transplantation to address this issue in patients with ADPLKD
The indication for the modified simultaneous liver and kidney transplantation technique was patients with ADPLKD showing at least a doubled physiological liver [15] and kidney [16] volume according to preoperative diagnostics as well as ADPLKD-associated complications
Summary
One indication for simultaneous organ transplantation is autosomal dominant polycystic liver and kidney disease (ADPLKD) (Potter III). In the presence of ADPLKD, massive enlargement of the liver and kidney caused by the cysts [4] can occur in up to 78% of patients [5, 6]. These patients mainly suffer from nonspecific clinical symptoms due to the massive organ enlargement, the position and size of individual cysts. In 42% of all patients with type II and III ADPLKD, simultaneous liver and kidney transplantation are necessary [8, 10]
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