Combined liver-kidney transplantation in polycystic disease: case reports.
Polycystic disease causes a progressive decrease in renal function and liver degeneration. The progression of the disease evolves separately between organs and transplantation options vary: simultaneous or sequential liver-kidney transplantation or single-organ transplantation. From September 2006 to June 2007 3 combined liver kidney transplantations (CLKT) were performed for polycystic disease with end-stage renal disease: 2 with polycystic liver disease, and 1 with hepatic failure due to congenital hepatic fibrosis. The widest dimensions of the polycystic liver of 50 and 60 cm diameter were due to extensive cystic degeneration. We performed 1 simultaneous CLKT and 2 sequential transplantations: 1 liver after kidney, and 1 kidney after liver. At present all patients are alive with 100% graft function. Median creatinine level at discharge was 0.9 mg/dL (ranges, +/-0.2). Good liver graft function was reported in all 3 cases. Transplant benefit in polycystic liver-kidney disease has been already demonstrated; conservative surgical options may result in a high incidence of complications in highly involved polycystic livers. Delaying transplantation results in a more difficult surgical technique, a higher rate of postoperative complications, and a disturbance of optimal graft retrieval because of the worse preoperative condition of the patients.
Rossi
M
M
Chirurgia Generale e Trapianti d'Organo, La Sapienza Università di Roma, Umberto I Policlinico di Roma, Rome, Italy. m.rossi@uniroma1.it
Spoletini
G
G
Bussotti
A
A
Lai
Q
Q
Travaglia
D
D
Ferretti
S
S
Poli
L
L
Ginanni Corradini
S
S
Merli
M
M
Novelli
G
G
Mennini
G
G
Pugliese
F
F
Berloco
P B
PB
D000328:Adult; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D007690:Polycystic Kidney Diseases / Q000601:surgery*