肝、肾联合移植六例报告

目的 交流肝、肾联合移植的体会。方法 对6例患者施行肝、肾联合移植，其原发病4例为慢性肾炎、乙型肝炎后肝硬化，1例为乙型肝炎相关性肾炎、原发性肝癌，1例为多囊肝、多囊。肾。术后应用环孢素A（或他克莫司）、霉酚酸酯及甲泼尼龙预防排斥反应，4例乙型肝炎后肝硬化患者同时口服拉米夫定，并短期使用抗乙型肝炎球蛋白。结果 术后6例移植肝功能迅速恢复正常，5例移植肾功能在术后1周内恢复正常，1例移植肾功能恢复延迟，经支持性血液透析治疗，于术后第52d血肌酐恢复正常。术后6例患者出现胸腔积液，其中2例需穿刺引流；2例发生细菌性肺炎和卡氏肺囊虫肺炎；3例术后早期需行降脂治疗。目前6例患者均存活，且移植肝和移植肾功能均正常。1例术前群体反应性抗体（PRA）为23％，术后PRA稳定在8％左右。4例乙型肝炎后肝硬化的患者术后血清乙型肝炎表面抗原和乙型肝炎病毒DNA转阴。结论 肝、肾联合移植治疗终末期肝、肾疾病具有较好的近期疗效。

Initial experience of 6 cases of combined liver-kidney transplantation at a single center

Objective To investigate the experiences of combined liver-kidney transplantation (CLKTx).Methods Six patients underwent CLKTx in our center. The primary diseases included chronic glomerulonephritis and post-hepatitis B cirrhosis in 4 patients, hepatitis B virus associated nephritis and primary hepatocellular carcinoma in 1 patient, and polycystic kidney and polycystic liver in 1 patient. Cyclosporine A (or tarcrolimus), mycophenolate mofetil and methylprednisolone were applied to prevent rejection. Four cases of post-hepatitis B cirrhosis received lamivudine. And hepatitis B immunogloblin was given to 4 patients for a short term.Results All 6 liver grafts had good primary function. Five renal grafts had good primary function within one week post-transplantation. One patient with delayed kidney graft function needed supportive hemodialysis. The serum creatinine was declined to normal level 52 days post-operation. Pleural effusion occurred in all 6 patients among which 2 patients needed surgical drainage. Two patients had to be treated for bacterial pneumonia and pneumocystis carinii pneumonia respectively. Three patients needed lipid-lowering therapy at early time post-operation. At the last follow-up, all 6 patients were alive with normal renal graft function and liver graft function. The panel reactive antibody (PRA) of one patient was 23 % before transplantation, and remained at about 8 % post-transplantation. The serum HBsAg and HBV DNA of all 4 post- hepatitis B cirrhosis patients became negative post-transplantation.Conclusion CLTx is a safe procedure for combined hepatic and renal end-stage disease with excellent short-term results.