PMC5264203_01
PMC5264203_02
(a) Diagrammatic representation of the donor, after liver was harvested after transecting aorta and vena cava just above the origins of renal arteries and drainage of renal veins, respectively. (b) En-bloc harvest of both the kidneys with donor aorta and inferior vena cava and both ureters up to bladder
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F1
The hepatobiliary surgery team retrieved the liver after transecting the aorta and vena cava just above the origins of the renal arteries and drainage of renal veins, respectively [Figure 1a]. Infrahilar aorta and vena cava were divided at the level of their branching into the iliac vessels, and both ureters were dissected till their entry into the bladder [Figure 1b].
(a) Bench preparation, closing the cephalic ends of both aorta and inferior vena cava. (b) Bench preparation, posterior aspect of harvested kidneys, all the branches were suture tied. RK: Right kidney, LK: Left kidney. (c) Diagrammatic representation after the en-bloc transplant is complete. Ao: Aorta, IVC: Inferior vena cava, EIA: External iliac artery, EIV: External iliac vein
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F2
Bench preparation included the closure of suprarenal transected aorta and cava [Figure 2a] using 6-0 polypropylene suture. All the branches of the aorta and vena cava were ligated except for the renal blood supply [Figure 2b]. Both the ureters were anastomosed separately into the bladder using modified Lich-Gregoir technique over double-J stents [Figures 2c and 3].
Intraoperative photograph of completed en-bloc transplant
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F3
Both the ureters were anastomosed separately into the bladder using modified Lich-Gregoir technique over double-J stents [Figures 2c and 3].