CMV specific T cell immune response in hepatitis C negative kidney transplant recipients receiving transplant from hepatitis C viremic donors and hepatitis C aviremic donors

Kidney transplants (KT) from hepatitis C (HCV) viremic donors to HCV negative recipients has shown promising renal outcomes, however, high incidence of cytomegalovirus (CMV) viremia were reported. We performed a prospective cohort study of 52 HCV negative KT recipients from Methodist University Hospital including 41 receiving transplants from HCV aviremic donors and 11 from HCV viremic donors. CMV specific CD4+ and CD8 + T cell immunity was measured by intracellular flow cytometry assay. Primary outcome was the development of positive CMV specific CD4+ and CD8 + T cell immune response in the entire cohort and each subgroup. The association between donor HCV status and CMV specific CD4+ and CD8 + T cell immune response was analyzed by Cox proportional hazard models. Mean recipient age was 48 ± 13 years, with 73% male and 82% African American. Positive CMV specific CD4+ and CD8 + T cell immune response was found in 53% and 47% of the cohort at 1 month, 65% and 70% at 2 months, 80% and 75% at 4 months, 89% and 87% at 6 months, and 94% and 94% at 9 months post-transplant, respectively. There was no significant difference in the incidence of positive CMV specific T cell immune response between recipients of transplants from HCV aviremic donors compared to HCV viremic donors in unadjusted (for CD8+: HR = 1.169, 95%CI: 0.521–2.623; for CD4+: HR = 1.208, 95%CI: 0.543–2.689) and adjusted (for CD8+: HR = 1.072, 95%CI: 0.458–2.507; for CD4+: HR = 1.210, 95%CI: 0.526–2.784) Cox regression analyses. HCV viremia in donors was not associated with impaired development of CMV specific T cell immunity in this cohort.     

Chronic liver disease in kidney recipients with hepatitis C virus infection

BACKGROUND: The prevalence of anti-hepatitis C virus (HCV) positive test is higher among patients in dialysis and in kidney recipients than in general population. Hepatitis C virus infection is the main cause of chronic liver disease in renal transplant patients. Liver biopsy and virological analysis were performed to clarify the grade of liver damage in kidney recipients. METHODS: Renal recipients patients with at least 5 yr under immunosuppression were submitted to clinical and laboratory analysis. Patients who tested anti-HCV positive were candidates to liver biopsy with no regard to transaminase levels. RESULTS: Forty-five patients tested anti-HCV positive and 42 anti-HCV negative. Twenty-six anti-HCV and RNA-HCV positive patients were submitted to liver biopsy. Seventy-three percentage of these patients presented chronic active hepatitis, from these only one patient presented cirrhosis. Only 29% of the anti-HCV positive group presented elevated alanine aminotransferase levels. Anti-HCV positive patients presented longer previous time on dialysis and less rejection episodes than the group anti-HCV negative (p < 0.05). All anti-HCV positive patients but one tested RNA-HCV positive by polymerase chain reaction (PCR). CONCLUSIONS: In this series the prevalence of anti-HCV positive is 51.7%. Most of the patients presented liver damage in histology caused by HCV. However, we found only mild or minimal fibrosis and inflammatory activity grade, despite 10 yr of HCV infection and 5 yr of immunosuppressive treatment. Only one patient presented cirrhosis (4%). Performing serial liver biopsies in a long-term follow-up is needed to clarify the impact of HCV infection in renal transplant patients.     

Rapid steroid withdrawal in hepatitis C virus-positive kidney transplant recipients

The effects of rapid steroid withdrawal (SW) on kidney transplantation (KT) outcome were investigated in 12 HCV+ patients in a prospective cohort study. These results were compared with 17 HCV+ patients who received KT in the prior 2 yr and treated with a standard prednisone taper protocol. SW patients received only 6 d of steroid treatment after transplantation. Eleven received Thymoglobulin and one Basiliximab induction treatment along with a calcineurin inhibitor and mycophenolate mofetil. Patient and graft survival was 92% in SW group (median follow-up 12 months, range 6-17), and 92 and 82% in the historic control group respectively (median follow-up 21 months, range 11-27). In the SW and control group, acute rejection rates were 9 and 18%, and mean creatinine levels at last follow-up 1.30 +/- 0.36 and 1.68 +/- 0.58 mg/dL respectively. Only two SW patients had an increase in liver function tests during follow-up (18%), compared with six patients in the control group (43%). This study demonstrates that rapid SW is safe for HCV+ KT recipients, without an increase in acute rejection episodes or liver function abnormalities in the short term.     

Liver transplantation in children using organs from young paediatric donors

Nowadays, most paediatric liver transplant recipients receive a split or other technical variant graft from adult deceased or live donors, because of a lack of available age‐ and size matched paediatric donors. Few data are available, especially for liver grafts obtained from very young children (<6 years). We analysed all paediatric liver transplantations between 1989 and 2009. Recipients were divided into five groups (1–5) depending on donor age (<1, ≥1 to <6, ≥6 to <16, ≥16 to <45, ≥45 years). Overall, 413 paediatric liver transplantations from deceased donors were performed; 1‐ and 5‐year graft survival rates were 75%, 80%, 78%, 81%, 74% and 75%, 64%, 70%, 67%, 46%, and 1‐ and 5‐year patient survival rates were 88%, 91%, 90%, 89%, 78% and 88%, 84%, 84%, 83%, 63% for groups 1–5, respectively, without significant difference. Eight children received organs from donors younger than 1 year and 45 children received organs from donors between 1 and 6 years of age. Overall, vascular complications occurred in 13.2% of patients receiving organs from donors younger than 6 years. Analysis of our data revealed that the usage of liver grafts from donors younger than 6 years is a safe procedure. The outcome was comparable with grafts from older donors with excellent graft and patient survival, even for donors younger than 1 year.     

Older donors and kidney transplantation

Reluctance to use kidneys from older donors (>50 years of age) is based on reports of inferior results. We reviewed our experience with 45 kidneys transplanted from older donors. Primary nonfunction, immediate graft function, and 1-, 2- and 3-year graft survival rates were similar to those obtained with kidneys transplanted from donors aged between 20 and 40 years. Renal function at 1 year (as measured by serum creatinine) was poorer in kidneys from older donors. No beneficial effect with respect to graft survival was noted with cyclosporin therapy compared to conventional immunosuppression; however, the numbers are small. We conclude that kidneys from older donors are a valuable source for transplantation.     

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.     

Iranian kidney donors: motivations and relations with recipients

PURPOSE: The motivations of Iranian kidney donors and donor-recipient relationships are clarified. MATERIALS AND METHODS: A 13-page 69-item questionnaire was completed by 100 donors and interviews were videotaped. RESULTS: Of the donors 90% did not knew the recipients preoperatively and only 13% had any information on recipient fate postoperatively. In 87% of cases there was no postoperative relationship. Because of recipient failure to appreciate the donors and refusal to realize preoperative promises 51% of donors hated the recipients and 82% were unsatisfied with their behavior. Motivations for donating were purely financial in 43% of cases and mainly financial with a minor altruistic component in another 40%. Of the donors 76% agreed that kidney sale should be banned and if there was another chance they would prefer to beg (39%) or obtain a loan from usurers (60%) instead of vending a kidney. All 6 related donors were paid. The goals of vending were achieved not at all by 75% of donors. CONCLUSIONS: None of the donors studied fulfilled the criteria of compensated donation or donation with an incentive and 97% were vendors. All evidence shows that the donor-recipient relationship in Iran is pathological with no similarity to the emotionally related category of transplantation. Reports by the reformist Iranian press, which have all been banned, show that our sample is a good representative of other Iranian donors. Almost none of the criteria of an acceptable living unrelated renal donor transplant program is met in Iran. The opinion of kidney donors should be regarded as the final arbiter when labeling the act as a sale or donation and it should be considered in discussions of living unrelated donor transplantation.     

Renal transplantation from seropositive hepatitis C virus donors to seronegative recipients in Spain: a prospective study

Hepatitis C virus (HCV) positive donors are identified in Spain by antibody detection (HCV‐Ab) techniques while a HCV nuclear acid‐testing (HCV‐NAT) is not mandatory. Since it has been shown that HCV‐Ab positive HCV‐NAT negative donors do not universally transmit the infection, we designed a protocol based on the identification of viremia in HCV‐Ab positive donors to start treatment if needed. HCV‐Ab‐positive donors were identified and we performed HCV‐NAT immediately. Donors coinfected with HIV were excluded. Recipients with a low chance to receive a transplant, with no history of liver disease and who were negative for HCV‐Ab were selected after informed consent was signed. Kidney recipients from HCV‐NAT‐positive donors received glecaprevir and pibrentasvir from 6 h before the transplant until 8 weeks after. Recipients from HCV‐NAT‐negative donors were not treated. Regular monitoring by HCV‐NAT was performed to initiate antiviral treatment. We included 11 recipients from six deceased donors Four recipients received grafts from HCV‐NAT‐positive donors and seven patients received grafts from HCV‐NAT‐negative donors. None of our recipients exhibited HCV‐NAT positivity during the minimum follow‐up period of 6 months. Recipients from HCV‐NAT‐positive donors exhibited sustained virologic response at 12 weeks. One recipient from an HCV‐NAT‐negative donor lost his graft via a process thought to be unrelated to HCV. The remaining 10 patients had a stable functioning graft at the end of the follow‐up period. Our preliminary data suggest that renal transplantation from HCV‐Ab‐ positive donors to HCV‐Ab negative recipients is safe when only the recipients of organs from HCV‐NAT‐positive donors are treated.     

Current state of kidney transplantation in patients with HIV,hepatitis C,and hepatitis B infection

Human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV) are common chronic viral infections in the end-stage kidney disease (ESKD) patient population that were once considered relative contraindications to kidney transplantation. In this review, we will summarize the current state of kidney transplantation in patients with HIV, HCV, and HBV, which is rapidly evolving. HIV+ patients enjoy excellent outcomes in the modern transplant era and may have new transplant opportunities with the use of HIV+ donors. Direct-acting antivirals for HCV have substantially changed the landscape of care for patients with HCV infection. HBV+ patients now have excellent patient and allograft survival with HBV therapy. Currently, kidney transplantation is a safe and appropriate treatment for the majority of ESKD patients with HIV, HCV, and HBV.     

Long-term lamivudine monotherapy prevents development of hepatitis B virus infection in hepatitis B surface-antigen negative liver transplant recipients from hepatitis B core-antibody-positive donors

BACKGROUND: Liver transplantation from hepatitis B core-antibody (HBcAb)-positive donors to hepatitis B surface-antigen (HBsAg)-negative recipients has been associated with a risk of hepatitis B virus (HBV) infection in the absence of antiviral prophylaxis. The aim of this study is to assess the efficacy of long-term lamivudine monotherapy to prevent development of HBV infection in HBsAg-negative recipients of liver allografts from HBcAb-positive donors. METHODS: From 315 cadaveric adult liver transplantations performed at our unit between July 1999 and March 2005, 18 recipients (5.7%) received liver allografts from HBcAb-positive donors, 13 of whom were HBsAg-negative pre-transplantation. The recipients consisted of four females and 14 males, age range 28-65 yr (median 49.5 yr). Post-transplantation, HBsAg-negative recipients were administered lamivudine 100 mg daily long term. HBsAg-positive recipients were administered low-dose hepatitis B immunoglobulin (HBIg) and lamivudine according to our usual protocol. Standard post-transplantation immunosuppression was given. Recipients were followed up regularly (range 2-69 months, median 21 months) for development of de novo HBV infection. RESULTS: Ten HBsAg-negative recipients received long-term lamivudine. One patient (HBcAb and HBsAb positive pre-transplant) did not receive lamivudine and, in two patients, lamivudine was discontinued following urgent re-transplantation for primary graft non-function. All 13 of the HBsAg-negative recipients were still alive, with no evidence of HBV infection at the end of follow-up. CONCLUSION: Long-term lamivudine monotherapy was effective in preventing development of HBV infection in HBsAg-negative liver transplant recipients from HBcAb-positive donors.     

Use of telbivudine in kidney transplant recipients with chronic hepatitis B virus infection: A preliminary experience

Telbivudine is a relatively novel oral nucleoside analogue with favourable efficacy and tolerability in treatment‐naïve chronic hepatitis B virus (HBV) infection, but its data in kidney transplant recipients (KTRs) was lacking. The efficacy and tolerability of telbivudine in four treatment‐naïve HBsAg‐positive KTRs were reviewed (treatment duration 54 (36–72) months) HBV DNA declined from 2.6 × 10⁵(7.8 × 10³–1.5 × 10⁷) copies/mL at baseline to 170 (0.0–3.2 × 10⁴) copies/mL at 12 months, and became undetectable at 24 and 36 months (P = 0.060, 0.118 and 0.005 compared with baseline). Alanine aminotransferase levels dropped from 46.5 (30–48) IU/mL at baseline to 28 (13–45) IU/mL, 34.5 (15–71) IU/mL and 26 (12–41) IU/mL at 12, 24 and 36 months, respectively (P = 0.109, 0.715 and 0.068 compared with baseline). Serum creatinine level and estimated glomerular filtration rate (eGFR) remained stable after 36 months of treatment (P all > 0.05 compared with baseline). No virological breakthrough, cirrhosis or hepatocellular carcinoma occurred. Our pilot data suggests that telbivudine has favourable efficacy and renal safety profiles in HBsAg‐positive KTRs.     

Direct‐acting antiviral regimens are safe and effective in the treatment of hepatitis C in simultaneous liver–kidney transplant recipients

Hepatitis C (HCV) remains the single most common etiology of end‐stage liver disease leading to simultaneous liver/kidney transplant (SLKT) and has worse post‐transplant survival compared to non‐HCV patients. We aim to assess the effectiveness and tolerance of the all‐oral direct‐acting antiviral (DAA) agents with or without ribavirin (RBV) in the treatment of HCV recurrence post‐SLKT. Thirty‐four patients were studied retrospectively, composed predominantly of treatment‐naïve (73.5%) non‐Caucasian (61.8%) males (82.4%) infected with genotype 1a (64.7%). 94.1% reached a sustained virologic response (SVR) after 24 weeks (32/34 patients), without difference between 12 and 24 weeks of therapy. 64.7% had no clinical side effects. Three deaths occurred, all unrelated to treatment. One patient had liver rejection; tacrolimus was increased and prednisone was initiated while HCV treatment was continued and the patient ultimately achieved SVR. No liver graft losses. No kidney rejection or losses. We demonstrated that DAA combinations with or without RBV result in a remarkable SVR rate and tolerated in the majority of the studied SLKT patients. It is safe to wait to treat until post–kidney transplant and therefore increase the donor pool for these patients. Our cohort is ethnically diverse, making our results generalizable.     

Long-term kidney function and survival in recipients of allografts from living kidney donors with hypertension: a national cohort study

Allografts from living kidney donors with hypertension may carry subclinical kidney disease from the donor to the recipient and, thus, lead to adverse recipient outcomes. We examined eGFR trajectories and all-cause allograft failure in recipients from donors with versus without hypertension, using mixed-linear and Cox regression models stratified by donor age. We studied a US cohort from 1/1/2005 to 6/30/2017; 49 990 recipients of allografts from younger (<50 years old) donors including 597 with donor hypertension and 21 130 recipients of allografts from older (≥50 years old) donors including 1441 with donor hypertension. Donor hypertension was defined as documented predonation use of antihypertensive therapy. Among recipients from younger donors with versus without hypertension, the annual eGFR decline was −1.03 versus −0.53 ml/min/m² (P = 0.002); 13-year allograft survival was 49.7% vs. 59.0% (adjusted allograft failure hazard ratio [aHR] 1.23; 95% CI 1.05–1.43; P = 0.009). Among recipients from older donors with versus without hypertension, the annual eGFR decline was −0.67 versus −0.66 ml/min/m² (P = 0.9); 13-year allograft survival was 48.6% versus 52.6% (aHR 1.05; 95% CI 0.94–1.17; P = 0.4). In secondary analyses, our inferences remained similar for risk of death-censored allograft failure and mortality. Hypertension in younger, but not older, living kidney donors is associated with worse recipient outcomes.     

The impact of hepatitis C virus donor and recipient status on long-term kidney transplant outcomes: University of Wisconsin experience

Singh N, Neidlinger N, Djamali A, Leverson G, Voss B, Sollinger HW, Pirsch JD. The impact of hepatitis C virus donor and recipient status on long‐term kidney transplant outcomes: University of Wisconsin experience. Abstract: The survival benefit of transplanting hepatitis C (HCV)‐positive donor kidneys into HCV‐positive recipients remains uncertain. The purpose of this study was to assess the effect of HCV‐status of the donor (D) kidney on the long‐term outcomes in kidney transplant recipients (R). We evaluated 2169 consecutive recipients of deceased‐donor kidney transplants performed between 1991 and 2007. The following HCV cohorts were identified: D?/R? (n = 1897), D?/R+ (n = 59), D+/R? (n = 118), and D+/R+ (n = 95). Patients were followed for a mean of 6.02 (standard deviation = 4.26) yr. In a mulitvariable Cox‐proportional hazards model, D+/R+ cohort had significantly lower patient survival (adjusted‐hazard ratio [HR] 2.1, 95% CI [1.4–2.9]) with respect to the reference D?/R? group, whereas mortality was not increased in D?/R+ group. The rate of graft loss was increased in both D+/R+ and D?/R+ but was comparable with each other (adjusted‐HR 1.8, 95% CI [1.4–2.5]) vs. adjusted‐HR 2.0, 95% CI [1.4–2.8], respectively). D?/R+ cohort experienced significantly higher rate of rejection (adjusted‐HR 1.7, 95% CI [1.2–2.5]) and chronic allograft nephropathy (adjusted‐HR 2.1, 95% CI [1.2–3.7]). Neither donor nor recipient HCV‐status impacted the risk of recurrent or de novo GN. Transplanting HCV‐positive kidneys as opposed to HCV‐negative kidneys into HCV‐positive recipients provided similar graft survival but compromised patient survival in the long term.     

Corticosteroid elimination in simultaneous liver–kidney transplantation recipients

Abstract: Background: Simultaneous liver–kidney transplantation (SLK) has more than doubled since 2002. While less common in kidney transplant alone recipients (KTA), corticosteroid discontinuation is performed routinely in liver transplantation, raising the question of optimal immunosuppression for SLK recipients. Methods: A retrospective case series of 16 SLK recipients under a steroid withdrawal protocol was performed to compare short‐term outcomes to a contemporaneous cohort of 32 KTA recipients. Results: In 69% of SLK recipients, corticosteroids were eliminated compared to 3% of KTA recipients, p < 0.0001. When comparing SLK and KTA recipients one yr post‐transplant, there were no significant differences in renal graft rejection (23.1% vs. 6.3%), death‐censored renal graft survival (100% vs. 97%), estimated glomerular filtration rate (74.4 vs. 62.6 mL/min), serum creatinine (1.10 vs. 1.39 mg/dL), or maintenance immunosuppression, respectively. Conclusions: Corticosteroids may be withdrawn safely in SLK recipients with one‐yr renal outcomes comparable to a KTA cohort.     

老年活体供肾移植术后供者安全性及受者移植效果的分析

目的 分析老年活体供肾移植术后供者的安全性及受者的移植效果.方法 回顾性分析251例亲属活体供肾移植的临床资料.根据供者年龄,将251例活体供肾移植分为老年供肾组(≥55岁)和中青年供肾组(<55岁),对手术前后两组供、受者的血清肌酐(Cr)、肾小球滤过率(GFR)、内生肌酐清除率(Ccr)、并发症、平均住院时间以及受者的人/肾存活率、急性排斥反应发生率进行比较和分析.结果 老年供肾组和中青年供肾组供者手术前后血Cr水平的差异无统计学意义(P>0.05),而Ccr的差异有统计学意义(P<0.05).老年供肾组与中青年供肾组供者比较,术前总GFR、留存肾GFR及术后10 d留存肾GFR比较,差异均无统计学意义(P>0.05);老年供肾组供者术后10 d与术前的留存肾GFR比较,差异无统计学意义(P>0.05);中青年供肾组供者术后10 d的留存肾GFR较术前明显上升,差异有统计学意义(P<0.05).老年供肾组与中青年供肾组受者比较,手术前后各相应时间点的血Cr水平差异无统计学意义(P>0.05).老年供肾组和中青年供肾组供者平均住院时间分别为(16.67±7.78)d和(16.11±5.89)d(P>0.05),受者平均住院时间分别为(29.61±24.28)d和(28.76±19.27)d(P>0.05).两组受者6个月内急性排斥反应发生率分别为6.50%和5.75%(P>0.05).老年供肾组受者术后死亡1例,中青年供肾组死亡3例,并有1例因急性排斥反应切除移植肾.结论 老年活体供肾移植术前应对供者进行严格的选择,在进行全面系统评估的前提下,可以保证供者术后的安全以及受者的移植效果.     

Successful treatment of fibrosing cholestatic hepatitis with pegylated interferon,ribavirin and sofosbuvir after a combined kidney–liver transplantation

Fibrosing cholestatic hepatitis (FCH) is a classical but rare and severe form of recurrent hepatitis C virus (HCV) after liver transplantation. Classical anti‐HCV therapy, that is pegylated‐interferon (peg‐interferon) and ribavirin, has been shown to have limited efficacy in treating FCH. Herein, we report on the first case of successful use of peg‐interferon, ribavirin, plus sofosbuvir to treat HCV‐induced FCH in a combined liver–kidney transplant patient. Antiviral therapy was given for 24 weeks. HCV clearance occurred within 4 weeks after starting therapy and was maintained until 4 weeks after the end of therapy. Antiviral tolerance was good. We conclude that the use of sofosbuvir‐based anti‐HCV therapy can be successfully used to treat FCH after a liver or combined kidney–liver transplantation.     

肝肾联合移植术中肝脏对肾脏的保护作用

目的：探讨肝肾联合移植术中肝脏对肾脏的保护作用。方法：给1例肾移植术后移植肾失功并肝炎后肝硬化患者先行丧失功能移植肾切除术，术后第5天始每天口服环磷酰胺50mg，连服3个半月。经两次血浆置换，群体反应抗体(PRA)由66％降至22．5％，施行一期肝肾联合移植。供肝血流开放前及开放后每间隔半小时动态检测PRA，共7次，术后1个月、3个月、9个月复查PRA。术后免疫抑制治疗采用FK506、霉酚酸酯(MMF)和激素联合应用。结果：术后供肝、肾立即发挥功能，肝动静脉血流开放后，PRA由22．5％降至5％，并维持在7．5％(见图1)，术后未发生排斥反应现象。随访9个月，移植肝、肾功能正常，术后1个月、3个月、9个月复查PRA分别为7．5％、8．33％和7．5％。结论：肝肾联合移植术中肝脏对肾脏有一定的保护作用。