First Robotic Dual Liver-Kidney Transplant Expands Minimally Invasive Transplant Surgery

Patients with end-stage liver disease often develop renal failure, creating the need for simultaneous liver-kidney transplantation. Traditional open dual-organ transplantation requires large incisions and can prolong recovery in medically fragile patients. Although minimally invasive approaches may reduce surgical stress, they have not been established for complex multi-organ cases. Advancing this approach, Washington University School of Medicine in St. Louis and Barnes-Jewish Transplant Center have performed the world’s first reported robotic liver-kidney transplant.

The procedure was completed at Washington University School of Medicine in St. Louis and the Barnes-Jewish Transplant Center at Barnes-Jewish Hospital. The team built on a track record that includes one of the first robotic kidney transplants in the United States in 2020 and the nation’s first robotic liver transplant in 2023, both at the same center. Extending this program to a dual-organ case aimed to deliver the benefits of minimally invasive surgery to a highly vulnerable patient.

The surgeons performed the liver transplant first during an operation lasting just over eight hours. The console surgeon controlled robotic instruments using a highly magnified three-dimensional display, while a bedside surgeon provided manual assistance during critical steps. The donor liver was implanted through a single incision of about three inches, and vascular and biliary connections were completed through smaller secondary incisions.

The following morning, the team returned to the operating room to complete the kidney transplant using the same incisions. The graft reperfused promptly and began producing urine within minutes, indicating early function. In contrast, traditional open abdominal transplantation typically requires a 16- to 20-inch incision with significant division of abdominal musculature.

Both organs functioned immediately after surgery. By postoperative day 10, the patient’s mental clarity had improved with excellent graft performance, and within two weeks he climbed a short flight of stairs and continued mobilization with a walker while reporting minimal pain. The center performs around 20 combined liver and kidney transplants annually, and this case indicates robotic transplantation may be feasible for carefully selected dual-organ candidates.

“Patients who require simultaneous liver and kidney transplantation are often among the sickest and most fragile patients we care for. Their bodies are already under tremendous physiologic stress after months or years of advanced organ failure. Our goal with Darrell was to perform both transplants safely while minimizing the physical and psychological impact of surgery, giving him the best possible opportunity for a faster and smoother recovery,” said Adeel Khan, MD, professor of surgery at Washington University School of Medicine in St. Louis.

“It reflects years of experience, team development, and a thoughtful and deliberate commitment by WashU Medicine and Barnes-Jewish Hospital to advance surgical innovation in a safe and rigorous way. That infrastructure allows us to consider approaches for our patients that would not otherwise be possible. Our hope is that, over time, these approaches will allow more transplant patients to benefit from less invasive surgery and an easier recovery,” said Khan.

Related Links
Washington University School of Medicine
Barnes-Jewish Hospital