One-step SLK for polycystic disease is safe, feasible
Simultaneous liver and kidney transplantations (SLK) in polycystic diseases carried out through a one-step midline approach is effective, feasible, safe and may help avoid pre-transplant renal replacement therapy, a new study shows.
The study included 12 polycystic disease patients undergoing one-step SLK by midline laparotomy. Follow-up data including postoperative complications were evaluated against the 24 patients who received the classical two-step SLK.
The one-step SLK was carried out through a xiphopubic incision of the abdomen. Access to liver, native kidney and iliac fossae was achieved through bilateral cephalad retraction of the ribcage and lateral retraction of the abdominal wall.
The median follow-up for the 12 patients who received the midline laparotomy was 373 (120 to 684) days. Of these, 8 were performed with a bilateral nephrectomy and 4 with unilateral nephrectomy. No complications were recorded.
Between those who received one-step and two-step SLK, there were no statistically significant differences in donor and recipient body mass index, age and gender distribution, Model of End Stage Liver Disease scores and preoperative need for blood product transfusion.
All patients showed good signs of recovery and transplants were observed to function immediately. There was no significant difference in surgical complications within 90 days between the one-step and two-step SLK groups.
Finally, patient and graft outcomes and length of stay in the intensive care unit were not significantly different between the two groups. Two deaths were recorded in the two-step SLK group.