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, Sylvester Black, Ken Washburn, Ashraf El-Hinnawi

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)13-16
Number of pages4
JournalInternational Journal of Surgery Case Reports
Volume53
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Splenic Artery
Renal Artery
Liver Transplantation
Kidney Transplantation
Stomach
Arteries
Kidney
Fatty Liver
alpha 1-Antitrypsin Deficiency
Transplants
Patient Discharge
Liver
Chronic Renal Insufficiency
Fibrosis
Ischemia
Pathology
Hypertension

Keywords

  • En bloc liver-kidney transplantation
  • Renal artery variation
  • Simultaneous liver-kidney transplantation

ASJC Scopus subject areas

  • Surgery

Cite this

En bloc liver-kidney transplantation with renal artery variation using donor splenic artery and left gastric artery as inflow to the kidney : Case report. / Nguyen, Michelle C.; Black, Sylvester; Washburn, Ken; El-Hinnawi, Ashraf.

In: International Journal of Surgery Case Reports, Vol. 53, 01.01.2018, p. 13-16.

Research output: Contribution to journalArticle

@article{924f6ebebcfa42b2a63084f664253ef4,
title = "En bloc liver-kidney transplantation with renal artery variation using donor splenic artery and left gastric artery as inflow to the kidney: Case report",
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",
author = "Nguyen, {Michelle C.} and Sylvester Black and Ken Washburn and Ashraf El-Hinnawi",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.ijscr.2018.10.002",
language = "English (US)",
volume = "53",
pages = "13--16",
journal = "International Journal of Surgery Case Reports",
issn = "2210-2612",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - En bloc liver-kidney transplantation with renal artery variation using donor splenic artery and left gastric artery as inflow to the kidney

T2 - Case report

AU - Nguyen, Michelle C.

AU - Black, Sylvester

AU - Washburn, Ken

AU - El-Hinnawi, Ashraf

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - En bloc liver-kidney transplantation

KW - Renal artery variation

KW - Simultaneous liver-kidney transplantation

UR - http://www.scopus.com/inward/record.url?scp=85055164991&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055164991&partnerID=8YFLogxK

U2 - 10.1016/j.ijscr.2018.10.002

DO - 10.1016/j.ijscr.2018.10.002

M3 - Article

C2 - 30366170

AN - SCOPUS:85055164991

VL - 53

SP - 13

EP - 16

JO - International Journal of Surgery Case Reports

JF - International Journal of Surgery Case Reports

SN - 2210-2612

ER -