肝、肾联合移植治疗肾移植术后移植肾功能衰竭并肝硬化一例报告

目的 报告1例移植肾功能丧失并肝炎后肝硬化者再次接受肝，肾联合移植。方法 给1例肾移植术后移植肾功能丧失并肝炎皇肝硬化患者先行失功能移植肾的切除。针对患者群体反应抗体（PRA）较高（66%），切除术后第5d开始每天给予环磷酰胺50mg。连服3个半月，并行血浆置换2次。PRA降至23%。3个半月后施行一期肝，肾联合移植，肝移植采用原位背驮式肝移植术式。供肾移植于左髂窝，肝血流开放后每间隔30min检测PRA1次，术后免疫抑制治疗采用他克莫司（FK506）。霉酚酸酯（MMF）和激素。结果 术后移植肝，肾立即发挥功能。肝动，静脉血流开放后，，PRA由23%降至5%。并维持在8%左右。术后乙型肝炎病毒表面抗原转阴，丙型肝炎病毒抗体阴性，随访3个月，移植肝，肾功能正常。结论 对于移植肾功能丧失，且合并有肝硬化，肝功能不良者，再次施行肝，肾联合移植是可行的。

One case of renal graft failure associated with cirrhosis following combined kidney and liver transplantation

Objective To explore the feasibility and effect of combined piggyback orthotopic liver and kidney transplantation in patient with renal graft function failure complicated with cirrhosis. Methods One patient with renal graft function failure complicated with cirrhosis was resected of renal graft. Daily dose of 50?mg CTX was given 5 days after operation and continued for 3.5 months. After two courses of plasma exchange, PRA was reduced from 66?% to 23?% . Combined kidney and liver transplantation was performed simultaneously using piggyback orthotopic liver transplantation technique,and the kidney graft was placed retroperitoneally in left iliac fossa. PRA was monitored every 30 min after liver reperfusion. Postoperative immunosuppressive therapy consisted of FK506, MMF and steroids. Results The kidney and liver grafts functioned normally after transplantation. PRA was reduced from 23?% to 5?% and maintained at 8?% . HBsAg and HCV were returned to negative. Kidney and liver grafts functioned well during a follow up of 3 months. Conclusion Combined liver and kidney transplantation is an effective rescue for loss of kidney graft complicated with cirrhosis, and liver graft can provide protection towards the kidney graft from the same donor.