Clinical Challenges in Transplant Surgery: Heart & Liver Transplant

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 19 September 2022

⏱️ 22 minutes

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Summary

In this episode we discuss two interesting cases in transplant surgery. In the first, we review a case in which a renal cell carcinoma was discovered during the backbench portion of a deceased donor kidney transplant procedure. In the second, we examine the unique challenges that are presented by simultaneous heart-liver transplantation.

Learning Objectives:
- Discuss renal cell carcinoma in the immunosuppressed patient
- Review some of the logistical components that accompany dual organ transplants
- Examine the clinical challenge of a heart-liver transplant

Hosts:
- Megan Lombardi, MD
- Sasha McEwan, MD
- Guilherme de Oliveira, MD
- Alexander Toledo, MD
- David Gerber, MD

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If you liked this episode, check out other transplant surgery episodes here: https://behindtheknife.org/podcast-category/transplant/

Transcript

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0:00.0	Hi and welcome to this episode of Behind the Knife. I'm Megan Lombardi, a fourth-year resident
0:27.5	here at UNC. I'm Sasha McEwan, a third-year resident at UNC. I'm Gide de Veda, the chief resident
0:33.2	here at UNC. I'm Alex Deledo, transplant surgeon in the University of North Carolina,
0:38.5	and surgical director of the kidney transplant program. And I'm David Gerber, the chief of the
0:43.4	transplant program at UNC, and we're all very excited to still be with everybody. Today we'll be
0:49.0	discussing two cases, one of a combined heart liver and one of a RCC found in a donated kidney.
0:55.8	So this kidney case is a 71-year-old gentleman. He has ESRD secondary to biopsy proven FSGS,
1:02.5	and he was originally diagnosed with his CKD back in 2019, but was not yet on any hemodialysis.
1:09.7	He had a family history significant of lung cancer and some of his close first degree relatives.
1:16.4	He had a normal preoperative workup or his kidney transplant with several cat scans that showed
1:23.5	no abnormal anatomy within his abdomen and multiple stable nodules in his lungs, but these were all
1:30.7	being monitored and were not significant. He, in which we'll get into, was diagnosed with a
1:38.8	papillary RCC on the day of his kidney transplant, and now he's well over his post-operative period,
1:46.6	and he's now had at least a one three-month scan that showed no residual or any new tumor bed.
1:53.6	So in terms of papillary renal cell cancer, they are responsible for about 80 to 85 percent of
1:58.7	all primary renal neoplasms. Most commonly these occur in males that are age 60 to 70,
2:05.0	and the survival is really good. A five-year survival rate per papillary RCC is about 75 percent now,
2:11.2	and the incidence has risen threefold higher than the mortality rate, likely due to our early
2:16.5	detection of tumors at smaller sizes. A small papillary RCC would be considered less than four
2:22.4	centimeters, and curative surgical treatments. There's two types, type one of papillary,
2:29.0	which tends to present earlier and have a met variant, whereas type two papillary is much more
2:34.3	aggressive and tends to present at advanced stages with a poor prognosis and has a genetic change
	...

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