肾移植术后肝功能衰竭的临床研究

Clinical study of hepatic failure in renal al-lograft recipients

我院自１９９１年１月至今共行尸肾栓植术４４４例．出现肝功能衰竭（ｈｅｐａｔｉｃｆａｉｌｕｒｅ，ＨＦ）９例，其中７例为ＨＢｓＡｇ或ＨＢｅＡｇ和ＨＢｓＡｇ阳性，２例ＨＣＶ抗体阳性，术后ＨＦ分别占ＨＢｓＡｇ和ＨＣＶ抗体阳性患者的１３．７％和２０％，总发病率为２．０２％。ＨＦ早期病情隐匿，起病急，病程短，与病毒性肝炎关系密切，治疗棘手，且并发症多，多伴有严重感染，预后极差。本组９例全部死亡，严重影响患者及移植肾的长期存活。本文对ＨＦ的发病原因、临床特性、治疗及预后、预防进行了分析和讨论。

avaderic kidney transplantations wereperformed in 444 patients frorn Jan 1991 tonow. Among them , 9 patients suffered fromhepatic failure (HF). Clinically ,HF in graftkidney recipients is characterized by insidi-ous symptoms , shorter course (less than 4years ) ,no effective treatment and high mor-tality rate (100%). Byanalyzing our data ,we also found HF was closely associated vi-ral hepatitis : 13. 7% of the HBV sero-posi-tive and 20% of the HCV sero-positive pa-tients developed HF. On the other hand . 6 ofthe 9 cases with HF were HBV sero-positiveand 2 of thein were antiHCV sero-positive.Since HF in graft kidney recipients severelyaffects the longterm survial of the pa-tients, we suggest that HCV sero-positivebe listed as a relative contraindication forrenal transplantation ;and intense preventivemeasures be taken, including abstinencefrom alcohol and cigarette , discontinuatioinof hepatic toxic agents and prophylectic useof interferona if necessary.