Incidence of renal and liver rejection and patient survival rate following combined liver and kidney transplantation
Incidence of renal and liver rejection and patient survival rate following combined liver and kidney transplantation
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DOI：
10.1034/j.1600-6143.2003.00050.x
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发表时间：
2003-03-01
影响因子：
8.8
通讯作者：
Charpentier, B
中科院分区：
文献类型：
--
作者：
Creput, C;Durrbach, A;Charpentier, B
多器官移植用于治疗慢性多器官衰竭。然而，长期死亡率和移植物耐受性仍有待评估。我们对45例接受来自同一供体的肝肾联合移植（LK）的患者进行了回顾性和比较性分析。他们与86名接受肾移植（KT）的匹配患者进行了比较。所有患者均患有与肝硬化（n = 35）或遗传性疾病（n = 10）相关的器质性肾衰竭。19例（42.9%）既往接受过移植。患者1年生存率为85%，3年生存率为82%。7名患者在前3个月内死于严重的多种微生物感染。LK人群中有2例患者（4.2%）发生了肾移植急性排斥反应，而86例匹配的肾移植患者中有24例（32.6%）发生了急性排斥反应。同时，在LK人群中的14例病例（31.1%）中观察到急性肝排斥反应。急性排斥反应的发生与组反应性淋巴细胞毒性抗体（n = 16）无关，也与阳性交叉配型（n = 3）无关。45例患者中有4例（8.8%）发生慢性移植肾排斥反应，16例（42.2%）发生慢性肝功能障碍。总之，肝肾联合移植后的总体生存率是可以接受的，LKT可建议用于伴有肝功能障碍、原发性尿失禁或淀粉样神经病的肾功能衰竭患者。这一人群的主要死亡原因是严重感染并发症。急性排斥反应发生率低于单次移植。
Multiple organ transplantations are used to treat chronic multiple organ failure. However, long-term mortality and graft tolerance remain to be evaluated. We carried out a retrospective and comparative analysis of 45 patients who underwent a combined liver and kidney (LK) transplantation (LKT) from the same donor. They were compared to 86 matched patients who underwent kidney (K) transplantation (KT). All patients had an organic renal failure associated with cirrhosis (n = 35) or with inherited disease (n = 10). Nineteen (42.9%) had been transplanted previously. The patients' survival rate was 85% at 1 year and 82% at 3 years. Seven patients died within the first 3 months, due to severe polymicrobial infection. Two patients in the LK population (4.2%) developed acute rejection of the kidney graft compared to 24 of the 86 matched renal transplanted patients (32.6%). In parallel, acute liver rejection was observed in 14 cases (31.1%) in the LK population. The occurrence of acute rejection was not associated with panel-reactive lymphocytotoxic antibodies (n = 16), nor with positive cross-matches (n = 3). Four of the 45 patients (8.8%) subsequently developed chronic renal allograft rejection, and 16 cases of chronic hepatic dysfunction were noted (42.2%). In conclusion, the overall survival rate following combined liver kidney transplantation is acceptable, and LKT can be proposed to patients with kidney failure associated with liver dysfunction, primary oxaluria or amyloid neuropathy. The main cause of mortality in this population was severe infectious complications. The frequency of acute kidney rejection was lower than in single transplantation.