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。

A preliminary observation of liver graft''''s protective effects for kidney graft in combined liver-kidney transplantation

Objective:To explore whether the liver graft has protective effects for the kidney graft when transplanted simultaneously from the same donor.Methods:A patient with failure renal graft function complicated with cirrhosis was resected of renal graft. Daily dose of 50 mg CTX was given 5 days after operation and continued for three and half months. After two courses of plasma exchange,PRA was reduced from 66% to 22.5%. Combined kidney and liver transplantation were performed simultaneously,PRA was monitored every half hour after liver reperfusion,postoperative immunosuppressive therapy consisted of FK506,MMF,and steroids.Results:The kidney and liver grafts functioned normally after transplantation. PRA reduced from 22.5% to 5% and maintained 7.5%. Kidney and liver grafts functioned well and PRA was about 8.33% or so in nine months of follow up.Conclusion:Liver graft has protective effects for kidney graft from the same donor in combined liver and kidney transplantation.