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Letter to the Editor: Images in Nephrology
Triple functioning renal allograft after repeated liver–kidney transplantation due to liver failure
Funcionamiento de un triple trasplante renal alogénico tras repetir un trasplante de hígado-riñón por fallo hepático
Andrés Tapiasa, Nuria Sáncheza, José V. Torregrosab, David Fustera,
Autor para correspondencia
dfuster@clinic.ub.es

Corresponding author.
, Pilar Perlazaa, Francisco Lomeñaa
a Nuclear Medicine Department, Hospital Clinic, Barcelona, Spain
b Nephrology and Renal Transplant Department, Hospital Clinic, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 56-year-old woman who underwent 10 years earlier simultaneous liver&#8211;kidney transplantation due to polycystic disease &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41; showed progressive transaminase elevation secondary to hepatotoxicity due to venlafaxine&#46; The patient was diagnosed of liver rejection and retransplant was required&#46; However&#44; the patient also presented progressive renal failure worsened by liver failure &#40;Cr 4&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; so a second simultaneous liver&#8211;kidney transplant was performed to prevent subsequent dialysis&#46; Fifteen days later showed a prominent liver graft dysfunction and again was candidate for a new liver transplant&#46; At this point&#44; the second kidney graft was dysfunctional and considered as acute tubular necrosis by ultrasound&#46; A third simultaneous liver&#8211;kidney transplant was considered and finally performed without remarkable incidences &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Renogram has been widely used in the follow-up of renal transplant function and has proved reliable to define the integrity of the kidney&#46; The current case shows functional recovery of all three transplanted kidneys demonstrated by the renogram images &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41; and the correspondent generated curves for each renal transplant &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; To our knowledge&#44; this is a rare case not previously reported which raises the question about the need of systematic kidney transplantation when a liver transplant is required&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1&#44;2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Baseline CT coronal views show policystic kidneys before the first liver&#8211;kidney trasnsplantation &#40;A&#41;&#46; Follow-up CT locates the three transplanted kidneys in both sides of the pelvis &#40;B&#41;&#46; A renogram study using <span class="elsevierStyleSup">99m</span>Tc-MAG<span class="elsevierStyleInf">3</span> was performed identifying different degrees of radiotracer uptake in all three transplanted kidneys &#40;C&#41;&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">99m</span>Tc-MAG<span class="elsevierStyleInf">3</span> renogram curves were generated after drawing whole-kidney and background regions of interest for each renal transplant&#46; The results obtained were expressed as the maximum count ratios&#58; 200 cps &#40;A&#41;&#44; 117 cps &#40;B&#41; and 1640 cps &#40;C&#41;&#44; respectively&#46; The relative differential function showed the following distribution of 16&#37; for the right medial graft &#40;A&#41;&#44; 9&#37; for the left graft &#40;B&#41; and 75&#37; for the right lateral graft &#40;C&#41;&#46;</p>"
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                    0 => array:2 [
                      "titulo" => "Recovery of native renal function in patients with hepatorenal syndrome following combined liver and kidney transplant with mercaptoacetyltriglycine-3 renogram&#58; developing a methodology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;M&#46; Aparici"
                            1 => "S&#46;N&#46; Bains"
                            2 => "D&#46; Carlson"
                            3 => "J&#46; Qian"
                            4 => "D&#46; Liou"
                            5 => "D&#46; Wojciechowki"
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                      "doi" => "10.4103/1450-1147.172140"
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                        "tituloSerie" => "World J Nucl Med"
                        "fecha" => "2016"
                        "volumen" => "15"
                        "paginaInicial" => "44"
                        "paginaFinal" => "49"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26912978"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Evaluation of relative renal function for patients who had undergone simultaneous liver&#8211;kidney transplants using Tc-99m-MAG3 scintigraphy with attenuation correction from anatomical images and SPECT&#47;CT"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;R&#46; Palmer"
                            1 => "K&#46;J&#46; Donohoe"
                            2 => "J&#46;M&#46;A&#46; Francis"
                            3 => "D&#46; Mandelbrot"
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                      ]
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                  ]
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                    0 => array:2 [
                      "doi" => "10.1097/MNM.0b013e328347e958"
                      "Revista" => array:6 [
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                        "fecha" => "2011"
                        "volumen" => "32"
                        "paginaInicial" => "738"
                        "paginaFinal" => "744"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21659910"
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