Simultaneous orthotopic liver and orthotopic kidney transplantation: a comparison with the traditional surgical technique

Introduction: Simultaneous liver-kidney transplantation (SLKT) is performed by transplanting liver orthotopically and kidney heterotopically. We performed SLKT using another approach; simultaneous orthotopic liver and orthotopic kidney transplantation (SOLOKT), which has not been reported yet. We hypothesized that SOLOKT will lead to a shorter cold ischemia time (CIT) for kidney allograft, shorter ICU and hospital stay, and lower incidence of hematoma/fluid collection. Method: From Apr 2012 to Oct 2020, we performed 20 liver-kidney transplantations, with seven of them as SOLOKT. Outcome variables included 90-day readmission rate, 1-year complications, 3-year death-censored liver and kidney grafts survival, and 3-year patient survival. Results: The two cohorts were similar in baseline characteristics with no differences in length of operation, CIT for liver and kidney allografts, use of narcotics during admission, readmission rate, and graft and patient survival (Table-1). There was increased EBL in SOLOKT as compared to SLKT [6500 vs 4000 ml, p-value=0.02]. Lengths of ICU and hospital stay were shorter, and complications were fewer in SOLOKT as compared to SLKT, however, it did not reach statistical significance. The advantages observed with SOLOKT are as follows: (1) Avoiding a surgical incision in the iliac fossa. (2) Preventing discard of a viable kidney with short ureter using uretero/pyelo-ureterostomy. (3) Simple dissection in renal fossa. (4) Not requiring any special expertise or extra instruments to perform.Tabled 1SOLOKT (n=7)SLKT (n=13)P-ValueLength of operation (mins), mean ± SD486.00 ± 62.78469.15 ± 68.530.596CIT Liver/Kidney (h:mm)6:59/8:586:22/9:120.564/0.833Estimated Blood Loss (ml), mean ± SD6500.00 ± 1802.784000 ± 978.090.019Length of ICU/hospital stay (d), mean ± SD2.86 ± 1.68/7.71 ± 3.408.46 ± 9.34/15.69 ± 15.830.055/0.209Total Morphine Milligram Equivalents (mg), mean ± SD202.45 ± 259.44277.55 ± 239.080.53090-Day Readmission Rate, mean ± SD1.71 ± 1.501.08 ± 0.950.258Hematoma/Fluid Collection, % [n]16.7 [1]41.7 [5]0.289Bacterial Infections, % [n]16.7 [1]25.0 [3]0.6883-Year Death-Censored Liver Graft/Kidney Graft/Patient Survival, %100/100/85.7100/92.3/84.6NA/0.463/0.871 Open table in a new tab Conclusions:SOLOKT can be performed advantageously with no added operative time or complications, have similar graft and patient outcomes, and yields better cosmetic results (Figure-1).