title: Simultaneous liver kidney transplantation and (bilateral) nephrectomy through a midline is feasible and safe in polycystic disease.
abstract: In Eurotransplant, 50% of simultaneous liver kidney transplantations (SLK) are performed for polycystic disease. Classically, liver and kidney are transplanted in two steps: liver through a subcostal incision, kidney through a separate oblique incision. Liver and kidney volume can make this 'two-step' procedure challenging, especially if simultaneous native nephrectomy is indicated. A 'one-step' SLK through a xiphopubic laparotomy might be a safe alternative, facilitating mobilization of the voluminous polycystic liver and native nephrectomy whilst offering access to iliac fossae for kidney transplantation. One-step SLK procedures for polycystic disease were introduced in 08/2013 at IKEM Prague (n = 6) and 11/2014 at University Hospitals Leuven (n = 6). Feasibility and safety of the one-step technique were investigated. We compared surgical data and outcomes obtained with the one-step technique to all consecutive two-step procedures performed for polycystic disease at the University Hospitals Leuven between 2008-2014 (n = 23). Median (interquartile range) are given. One-step SLK offered broad and adequate exposure for the hepatectomy, nephrectomies and transplantations, which were all uneventful. Morbidity, patient (100% vs 91%, p = 0.53) and graft survival (100% graft survival for liver and kidney in both groups) were comparable between one-step and two-step SLK. Liver cold ischaemia time was comparable [6.0 (4.4-7.6) vs. 7.1 (3.9-7.3), p = 0.077], kidney cold ischaemia time was shorter in one-step compared to two-step SLK [8.1 (6.4-9.3) vs. 11.7 (10.0-14.0), p<0.001)]. Total procedural time was also shorter in one-step compared to two-step SLK [6.8 (4.1-9.3) vs. 9.0 (8.7-10.1), p = 0.032], while all underwent bilateral (67%) or unilateral (33%) nephrectomy (compared to 0% and 52% in two-step SLK, respectively). In one-step SLK, 67% received a pre-emptive kidney transplant compared to 46% in two-step SLK. 5/12 two-step SLK became dialysis dependant after pre-transplant nephrectomy, the 4 dialysis-dependant patients with one-step SLK had not undergone pre-transplant nephrectomy. In conclusion, one-step SLK for polycystic disease is feasible and safe.
authors.affiliation: Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.|Department of Microbiology and Immunology, Lab of Abdominal Transplant Surgery, KU Leuven, Leuven, Belgium.
authors.forename: Ina
authors.identifier: http://orcid.org/0000-0003-4592-2810
authors.initials: I
authors.lastname: Jochmans
authors.affiliation: Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.|Department of Microbiology and Immunology, Lab of Abdominal Transplant Surgery, KU Leuven, Leuven, Belgium.
authors.forename: Diethard
authors.initials: D
authors.lastname: Monbaliu
authors.affiliation: Department of Microbiology and Immunology, Lab of Abdominal Transplant Surgery, KU Leuven, Leuven, Belgium.
authors.forename: Laurens J
authors.initials: LJ
authors.lastname: Ceulemans
authors.affiliation: Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.|Department of Microbiology and Immunology, Lab of Abdominal Transplant Surgery, KU Leuven, Leuven, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Pirenne
authors.affiliation: Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Fronek
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D007690:Polycystic Kidney Diseases / Q000601:surgery*