Nguyen Michelle C, Black Sylvester, Washburn Ken, El-Hinnawi Ashraf
Division of Transplantation, The Ohio State University Wexner Center, 395 W 12th Avenue, Columbus, OH, 43210, USA.
Division of Transplantation, The Ohio State University Wexner Center, 395 W 12th Avenue, Columbus, OH, 43210, USA.
Int J Surg Case Rep. 2018;53:13-16. doi: 10.1016/j.ijscr.2018.10.002. Epub 2018 Oct 8.
En bloc liver-kidney transplantation can be difficult with renal artery variations for which the risk of multiple anastomoses can outweigh the benefits.
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.
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.
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.
对于存在肾动脉变异的情况，整块肝肾联合移植可能会很困难，因为多处吻合的风险可能超过其益处。
本报告首次描述了使用具有双肾动脉的供体肾脏进行整块肝肾联合移植。肝肾联合移植的指征是非酒精性脂肪性肝炎（NASH）肝硬化合并继发于高血压和糖尿病并伴有肝肾综合征的慢性肾脏病。切除标本的病理检查结果与脂肪性肝炎相符，但确实存在PAS/D阳性的胞浆内小球，提示存在α-1抗胰蛋白酶缺乏的额外成分。
术中发现肾下极动脉血流减少，需要将肾下极动脉重新吻合至供体胃左动脉。术后过程无并发症，患者于术后第6天出院。
随着同期肝肾联合移植手术数量的增加，具有多条肾动脉的肾脏可以成功地整块移植，而不会影响缺血时间。
