Prevention and accident injury in the process of combined liver and kidney graft rapid harvesting        FU Bin-sheng, ZHANG Tong, LI Hua, et al. Liver Transplant Center, the Third  Affiliated  Hospital， Sun Yat-sen University, Guangzhou 510630, China
Corresponding author: CHEN Gui-hua, E-mail: chgh1955@263.net
Abstract    Objective    To evaluate accident injury in the process of combined liver and kidney graft rapid harvesting and summarize clinical experiences. Methods    From January 2008 to June 2009, a quick procedure for combined liver and kidney procurement was used in 232 cases. The clinical data of the cases, including accident injury of graft and anomalous hepatic arteries were analyzed retrospectively. The procedure included in situ perfusion through aorta and superior mesenteric vein plus drainage through inferior vena cava. Liver and kidney were separated after harvested en bloc. Results    Varied degree laceration of liver capsule existed in 25 cases (10.8%), and knife wound in left lobe of liver in 1 case. Primary non-function was found after implanted the severe fatty liver graft in 1 case. Kidney injury existed in 2 cases including 1 case of cuts in renal parenchyma of the right kidney and 1 cases of renal vein laceration in renal sinus, which were discarded because they could not be repaired. The first hepatic portal was cut at the high level during separation in 1 case. Anomalous hepatic arteries were found in 46 grafts (19.8%) with 76 percents of anomalous arteries originating from the left gastric artery and the superior mesenteric artery. Accident injury of anomalous hepatic artery was found in 3 cases (6.5%), including the left hepatic artery originating from the left gastric artery (2 cases) and the right hepatic artery originating from the superior mesenteric artery (1 case). Conclusion    Combined liver and kidney graft rapid harvesting is a simple and safe procedure, which can protect the quality of liver and kidney simultaneously. Adequate perfusion, skilled procurement techniques and the prevention of anomalous hepatic arteries injury are critical to assurance of graft quality.