肝、肾联合移植12例报告

Combined liver-kidney transplantation: a report of 12 cases

目的对肝、肾联合移植的临床情况进行总结。方法为12例肝、肾功能异常患者施行肝、肾联合移植,采用多器官联合切取术整块切取供者器官。8例行经典式肝移植,4例行背驮式肝移植,均未行体外静脉转流;肾移植为常规术式。术前进行抗CD25单克隆抗体和抗胸腺细胞球蛋白诱导治疗,术后应用他克莫司(FK506)、霉酚酸酯及泼尼松预防排斥反应。结果12例手术均获成功,移植肝及肾功能恢复良好。术后的并发症有移植肝急性排斥反应、FK506中毒、消化道出血、腹腔出血、肺部感染、腹腔感染(各1例次),所有患者均未发生移植肾急性排斥反应。结论肝、肾联合移植是治疗终末期肝病合并肾功能衰竭的理想选择。

Objective To explore the preliminary experience of combined liver-kidney transplantation. Methods Twelve patients were subjected to combined liver-kidney transplantation. The ortho topic liver transplantation was preceded with the classic fashion in 8 patients and the piggyback fashion in 4 patients. The pump-driven veuovenoas bypass technique was not used. And then the kidney trans- plantation was performed under stable homodynamic circumstance. The renal graft was implanted to the right iliac fossa routinely. The renal vein was anastomosed to the external iliac rein end-to-side, and the renal artery to the external iliac artery end-to-side or the hypogastric artery end-to-end. After operation, anti-CD25 monoclonal antibody or antithymocyte globulin （ATG）, tacrolimus （FK506）, mycophenolate mofetil and prednisone were used to prevent the allograft rejection. Results The sur- vival rate of the 12 cases receiving combined liver-kidney transplantation was 100%, and the graft function was restored well postoperation. An acute rejection episode of liver occurred in one patient. The FKS06 toxicity occurred in one patient. The hemorrhage of digestive tract occurred in one recipient and the hemorrhage of peritoneal cavity in one patient. The pneumonia occurred in one case and the peritoneal infection in one patient. No patient experienced any episode of acute rejection of renal allograft. Conclusions The combined liver-kidney transplantation is the ideal option of patients with end stage liver disease with chronic renal failure.