En bloc liver-kidney transplantation with renal artery variation using donor splenic artery and left gastric artery as inflow to the kidney: Case report

Introduction: En bloc liver-kidney transplantation can be difficult with renal artery variations for which the risk of multiple anastomoses can outweigh the benefits. Presentation of case: 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. Discussion: 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. Conclusion: 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.