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Kidney Week

Abstract: PO2166

Successful En Bloc Liver Kidney Transplant in a Morbidly Obese Patient

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Vargas, Paola, University of Virginia, Charlottesville, Virginia, United States
  • Leeds, Joseph T., University of Virginia, Charlottesville, Virginia, United States
  • Pelletier, Shawn, University of Virginia, Charlottesville, Virginia, United States
  • Goldaracena, Nicolas, University of Virginia, Charlottesville, Virginia, United States
  • Nishio Lucar, Angie G., University of Virginia, Charlottesville, Virginia, United States
Introduction

En bloc liver and kidney transplant is a variant for the traditional simultaneous liver kidney transplant (SLKT) technique that, with simultaneous reperfusion of both grafts through a common vascular anastomosis, can decrease operative time, cold ischemia time and risk of surgical site infections.

Case Description

A 50-year-old morbidly obese (BMI >50) male with history of ESRD due to hypertension, on hemodialysis for 4 years, decompensated NASH cirrhosis, Factor V Leiden, previous episodes of venous thromboembolism and obstructive sleep apnea presented for SLKT. The donor was brain dead with a KDPI 22%, anatomy was normal. On backtable, the donor right renal artery and splenic artery were anastomosed end-to-end to leave these arterial systems in continuity and perfused from the celiac trunk. The infrahepatic IVC cuff was sutured using an endovascular stapler to close the left renal vein orifice and distal IVC (Fig. 1A). The liver transplant was done with a piggyback technique with a side-to-side cavocavostomy. Reperfusion occurred simultaneously in both allografts from the arterial inflow followed by the venous inflow (Fig. 1B). Direct flow assessments by doppler was excellent. The ureter was anastomosed to the recipient's right native ureter in an end-to-side fashion followed by a double J ureteral stent. Total operative time was 7 hrs, 10 min, CIT 7 hrs and WIT 46 min. The postoperative course complicated by DGF for 3 weeks. He was discharged home on POD 6 and the ureteral stent was removed on POD 48.. At 3 months follow-up, the portal vein and renal artery remain patent and both allografts have excellent functioning without evidence of complications.

Discussion

This case illustrates that en block liver kidney is a feasible and effective option for well-selected patients. This technique should be considered in obese patients or those with extensive iliac arteries atherosclerosis who have increase morbidity with transplant and could benefit from single surgical incision. Close post transplant monitoring is key to surveil for potential complications.