肝肾联合移植的单中心经验总结

目的 分析单中心肝肾联合移植(SLKT)的治疗效果.方法 1999-2010年间共实施SLKT 21例,患者的原发疾病分别为多囊病11例,病毒性肝炎后肝硬化合并肝肾综合征5例,慢性肾炎肾功能衰竭合并肝硬化2例,肾移植术后移植肾功能丧失合并肝硬化2例,肝炎后肝硬化合并糖尿病肾病1例.统计患者的资料,与同期同中心"中国肝移植注册网站"收录的肝炎后肝硬化行肝移植的133例(LT组)和"中国肾移植科学登记系统"收录的尸体肾移植609例(KT组)进行对比,分析各组受者术前状态和预后的差异.结果 SLKT组术前终末期肝病模型(MELD)评分为21.3±5.5,血肌酐为(516.0±329.9)mmol/L;LT组术前MELD评分为20.6±9.9,血肌酐为(111.4±138.1)mmol/L,与SLKT组相比较,血肌酐的差异有统计学意义(P＜0.01).SLKT组中,3例分别于术后2周、半年和5年因感染而死亡,1例因多器官功能衰竭而死亡,1例于术后5年自行停药,因排斥反应而死亡.SLKT组术后1年内移植肾急性排斥反应的发生率为零,KT组为6 %(P＞0.05).术后SLKT组移植肾功能延迟恢复的发生率为9.5 %,KT组为17.3 %(P＞0.05).SLKT组术后1、3和5年的受者存活率分别为87.7 %、67.8 %和67.8 %,LT组分别为84.2 %、73.5 %和69.4 %(P＞0.05).结论 SLKT是终末期肝、肾疾病的有效、安全的治疗方法.

Abstract：

Objective To analyze the curative effect of simultaneous liver and kidney transplantation (SLKT) for patients with end-stage liver and kidney diseases and liver cirrhosis patients with hepatorenal syndrome.Methods All SLKTs (n=21) performed at our center from January 1999 to December 2010 were reviewed and SLKT outcomes were compared with those of kidney transplantation (KT) (n=609) and liver transplantation (LT) (n=133) performed during the same period.Results There were 3 deaths due to infection 2 weeks, 6 months and 5 years respectively after operation. One patient died due to multiple organ dysfunction syndrome 2 weeks after operation. One patient was dead 5 years after operation because of rejection. MELD level between SLKT and LT had no significant difference, but serum creatinine in SLKT group was significantly higher than in LT group (516.0±329.9 vs 111.4±138.1 mmol/L, P<0.01). The 1-year acute kidney rejection rate and rate of delayed graft function (DGF) of the kidney had no significant difference between SLKT group (0 vs 9.5 %) and KT group (6 % vs 17.3 %). There was no significant difference in one-, 3- and 5-year patient survival rate between SLKT group (87.7 %, 67.8 % and 67.8 %) and LT group (84.2 %, 73.5 % and 69.4 %).Conclusion SLKT is a safe and effective treatment for end-stage liver and kidney diseases.

Simultaneous liver-kidney transplantation: Single-center study

Objective To analyze the curative effect of simultaneous liver and kidney transplantation (SLKT) for patients with end-stage liver and kidney diseases and liver cirrhosis patients with hepatorenal syndrome.Methods All SLKTs (n=21) performed at our center from January 1999 to December 2010 were reviewed and SLKT outcomes were compared with those of kidney transplantation (KT) (n=609) and liver transplantation (LT) (n=133) performed during the same period.Results There were 3 deaths due to infection 2 weeks, 6 months and 5 years respectively after operation. One patient died due to multiple organ dysfunction syndrome 2 weeks after operation. One patient was dead 5 years after operation because of rejection. MELD level between SLKT and LT had no significant difference, but serum creatinine in SLKT group was significantly higher than in LT group (516.0±329.9 vs 111.4±138.1 mmol/L, P<0.01). The 1-year acute kidney rejection rate and rate of delayed graft function (DGF) of the kidney had no significant difference between SLKT group (0 vs 9.5 %) and KT group (6 % vs 17.3 %). There was no significant difference in one-, 3- and 5-year patient survival rate between SLKT group (87.7 %, 67.8 % and 67.8 %) and LT group (84.2 %, 73.5 % and 69.4 %).Conclusion SLKT is a safe and effective treatment for end-stage liver and kidney diseases.