Outcomes of liver-kidney transplantation in patients with primary hyperoxaluria: an analysis of the scientific registry of transplant recipients database
Outcomes of liver-kidney transplantation in patients with primary hyperoxaluria: an analysis of the scientific registry of transplant recipients database
复制标题
原发性高草酸尿症患者肝肾移植的结果：移植受者数据库科学登记的分析
DOI：
10.1186/s12876-020-01349-1
复制
发表时间：
2020-07-03
影响因子：
2.4
通讯作者：
Hu, Zhenhua
中科院分区：
文献类型：
--
作者：
Xiang, Jie;Chen, Zheng;Hu, Zhenhua
研究背景原发性高草酸尿症（PH）是一种肝脏草酸代谢酶缺乏的遗传性疾病，可导致不可逆的肾脏损害。目前，肝肾移植是用于治疗PH患者的治愈性但高度侵入性的疗法。然而，有限的研究集中在肝肾联合移植（CLKT）和肝肾序贯移植（SLKT）方法本研究纳入了201例PH患者，他们接受了肝脏和肾脏移植，并在移植科学注册表中列出1987年至2018年的获奖者。根据肝肾移植程序，将患者分为CLKT组和SLKT组。在每组中评估患者人口统计学和移植结果。结果与SLKT组相比，CLKT组在移植前透析的患者比例（p = 0.048）和移植前透析时间（p < 0.001）方面均差于SLKT组。SLKT组的供肾者和供肝者的人类白细胞抗原不匹配评分均高于SLKT组（p < 0.001和p = 0.003）。CLKT组利用了来自单个已故捐赠者的器官的比例更高（98.9%），而SLKT组利用了来自已故肝脏捐赠者的器官的75.0%，仅利用了来自已故肾脏捐赠者的器官的35.0%（p < 0.001）。通过肝移植（LT）或CLKT前血清肌酐浓度测量的肾功能在组间相似（p = 0.305）。两组之间的患者生存率无显著差异（p = 0.717），两组之间的肝脏（p = 0.685）和肾脏（p = 0.464）移植结局相当。结论SLKT似乎是CLKT的一种替代选择，但条件严格，仍需进一步探索。
Background Primary hyperoxaluria (PH) is an inherited disease lacking of hepatic oxalic acid metabolic enzymes which could lead to irreverisible renal damage. Currently, liver-kidney transplantation is a curative but highly invasive therapy used to treat patients with PH. However, limited studies have focused on combined liver-kidney transplantation (CLKT) and sequential liver and kidney transplantation (SLKT) in patients with PH. Methods The present study included 201 patients with PH who received both liver and kidney transplants and who were listed on the Scientific Registry of Transplant Recipients from 1987 to 2018. According to the liver-kidney transplant procedure, patients were separated into a CLKT group and a SLKT group. Patient demographics and transplant outcomes were assessed in each group. Results Compared with the SLKT group, The CLKT group got a worse pretransplant dialysis condition in both the proportion of patients under pretransplant dialysis (p = 0.048) and the duration of the pretransplant dialysis (p < 0.001). The SLKT group got higher human leukocyte antigen mismatch score of kidney donor (p < 0.001) and liver donor (p = 0.003). The CLKT group utilized higher proportion (98.9%) of organs from a single deceased donor, while the SLKT group utilized 75.0% of organs from deceased liver donors and only 35.0% of organs from deceased kidney donors (p < 0.001). Kidney function measured by serum creatinine concentration before liver transplantation (LT) or CLKT was similar (p = 0.305) between groups. Patient survival was not significantly different between the two groups (p = 0.717) and liver (p = 0.685) and kidney (p = 0.464) graft outcomes were comparable between the two groups. Conclusions SLKT seems to be an alternative option with strict condition for CLKT, further exploration about the SLKT is still required.