Simultaneous combined liver and kidney transplantation: a single center experience
Simultaneous combined liver and kidney transplantation: a single center experience
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DOI：
10.1111/j.1399-0012.2010.01168.x
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发表时间：
2010-05-01
影响因子：
2.1
通讯作者：
Heaton, Nigel D.
中科院分区：
文献类型：
--
作者：
Chava, Srinivas P.;Singh, Balbir;Heaton, Nigel D.
肾功能不全在等待肝移植（LT）的患者中是常见的，并影响LT后的结果。肝肾联合移植（CLKT）已被提议作为两个器官的慢性疾病患者的有效治疗方法，一些患者患有肝肾综合征和影响肾脏的肝脏代谢疾病。本研究旨在分析单中心CLKT的结果。在1992年至2007年间进行的2690例LT中，有39例CLKT;最常见的适应症是代谢性、肝硬化和多囊性疾病。随访170个月，11例死亡（总生存率71.8%）; 1年、5年和10年患者和肝移植存活率分别为77%、73.7%和73.7%，肾移植存活率分别为77%、70%和70%。代谢组的生存率（78.6%）似乎优于非代谢组（68%）;然而，这种差异并不显著（p = 0.39）。15例存活患者（53.6%）有轻度/中度肾损害（肌酐>= 125 μ mol/L）。无严重肾衰竭（血清肌酐>= 250 μ mol/L）或需要血液透析的终末期肾病。CLKT在选定的患者群体中具有良好的效果。在以肝为基础的代谢性疾病影响肾脏时，它为移植肾提供保护。肾脏急性排斥反应发生率低。大部分患者发生长期轻度/中度肾功能不全。仔细注意免疫抑制，以尽量减少肾毒性可能会有所帮助。
P>Renal dysfunction is common in patients awaiting liver transplantation (LT) and affects outcome following LT. Combined liver and kidney transplantation (CLKT) has been proposed as effective treatment for patients with chronic diseases of both organs, some with hepatorenal syndrome and for liver-based metabolic diseases affecting kidney. This study is undertaken to analyze results of CLKT at a single center. Of 2690 LTs performed between 1992 and 2007, there were 39 CLKTs; most common indications were metabolic, cirrhosis and polycystic disease. With follow-up of up to 170 months, 11 died (overall survival 71.8%); one-, five-, and 10-yr patient and liver graft survival is 77%, 73.7%, and 73.7%, respectively, and kidney graft survival is 77%, 70%, and 70%, respectively. Survival among metabolic group (78.6%) appeared to be better than non-metabolic group (68%); however, this difference was not significant (p = 0.39). Fifteen surviving patients (53.6%) have mild/moderate renal impairment (creatinine >= 125 mu mol/L). None has severe renal failure (serum creatinine >= 250 mu mol/L) or end-stage renal disease requiring hemodialysis. CLKT has good results in selected groups of patients. It provides protection to kidney allograft in liver-based metabolic diseases affecting kidney. The rate of acute rejection episodes of kidney is low. Significant proportion develops long-term mild/moderate renal dysfunction. Careful attention to immunosuppression to minimize nephrotoxicity may help.