D. Imai1, Y. Sambommatsu1, A. Sharma1, A. Khan1, S. Lee1, V. Kumaran1, A. H. Cotterell1, M. Saeed1, M. F. Levy1, D. A. Bruno1 1Virginia Commonwealth University, Transplant Surgery, Richmond, VA, USA
Introduction: Traditionally, simultaneous liver kidney transplantation (SLK) has been performed using a subcostal incision for the liver allograft and a lower abdominal incision for kidney transplantation (dual incision, DI). At our institution, we performed SLK using a single subcostal incision (SI). The aim of this study was to report the outcomes of single vs dual incisions for SLK.
Methods: A retrospective cohort study of consecutive 37 SLK procedures was performed. The demographic characteristics, complications, intraoperative findings, and complications after SI and DI were statistically compared.
All liver transplantations were performed through a bilateral subcostal incision with a midline vertical incision, as needed. A Thompson retractor was used to facilitate exposure. Kidney transplantation in the DI group followed either the completion of the liver transplantation or arterial anastomosis in the liver transplantation. Kidney transplantation in this group was performed through a separate lower abdominal oblique incision. The Thompson retractor was removed, and a Bookwalter retractor was used for kidney transplantation.
Kidney transplantation in the SI group was performed through the bilateral subcostal incision for liver transplantation by changing the position of the Thompson retractors to expose the external iliac vessels on the right side after the portal vein and the hepatic artery were reconstructed. The external iliac vessels and bladder were exposed and the kidneys were implanted. The Thompson retractor was readjusted for biliary anastomosis after the comletion of kidney transplantation.
Results: A total 37 SLK were performed (19 DI and 18 SI). The MELD score, age, and indications for transplantation were comparable between the two groups. Patient in SI group had significantly higher MELD score (27.0 ± 1.5 vs 31.7 ± 1.5, p= 0.038). The cold ischemic time of kidney transplantation (599 ± 26 min vs 447 ± 27 min, p< 0.001) and the total surgical time (508 ± 21 min vs. 423 ± 22 min, p= 0.008) were significantly shorter in the SI group. The incidence of complications and post-transplant kidney function was comparable between the groups. A slightly higher incidence of surgical site complications was noted in the DI group without any statistically significance (p= 0.178).
Conclusion: Single-subcostal incision SLK is technically feasible and has comparable outcomes to dual-incision SLK. SI was associated with shorter cold ischemic time for kidney transplant, as well as shorter overall operative time.
