肝肾联合移植及相关问题处理

目的探讨肝肾联合移植及其相关问题。方法对1例巨大的多囊肝、多囊肾患者和1例肝炎后肝硬化、肝癌合并肾功能衰竭患者实施一期肝肾联合移植。供体器官采用UW液原位灌注，快速切取。肝移植分别采用经典式或背驮式原位肝移植，肾移植采用常规方法。术后免疫抑制剂采用三联免疫方案。结果两例患者术后移植器官立即发挥功能。例1术后第2天发生急性肺损伤，第11天发生ARDS，经积极治疗后控制；例2肝、肾功能正常，未出现急性排斥反应和原发病复发等问题。结论肝肾联合移植是治疗肝肾终末期疾病的方法之一，完善的手术、严密的围手术期监测是肝肾联合移植成功的重要条件，肝肾联合移植手术可以取得良好的临床治疗效果，但在技术上较单纯的肝移植或肾移植要求更高、更复杂。

Simultaneous heptorenal transplantation and its relevant problems: a report of two cases

Objectives To investigate the surgical technique and some other related problems of simultaneous heptorenal transplantation. Methods Combined liver-kidney transplantation was performed in one patient with huge polycystic liver, bilateral kidney, and another with liver cirrhosis after hepatitis B complicated with hepatic carcinoma and uremia due to chronic nephritis. Donors' organs were infused in situ with UW solution and rapidly harvested. Orthctopic or piggyback liver tranlsplantation was carried out and the kidney was transplanted with conventional method respectively. The patients received an immunosuppression therapy including simulect (CD25 antibody), FK506 or CsA, Mycophenolate mofitil (MMF), and Predinision. Results Both transplanted organs rapidly functioned well after the operation. One patient recovered well but suffered from ALI (acute lung injury) on the 2nd postoperative day and ARDS on the 11th postoporative day. There were no acute rejection or recurrence of the primary diseases in both cases. Conclusions Simultaneous hepatorenal transplantation is one of the treatment methods for end stage liver and kidney diseases. Skillful operative technique, comprehensive perioperative monitoring and appropriate management are all important factors for obtaining a successful result. It requires more shillful techniques than single organ transplantation.