肝肾联合移植中肝脏对肾脏的保护作用

A liver graft from the same donor protect a kidney in combined liver-kidney transplantation

目的探讨肝肾联合移植中肝脏对肾脏的保护作用。方法回顾性分析2001年10月至2006年6月18例接受肝肾联合移植患者的资料,并以同一供体的对侧肾脏所完成的单独肾移植18例受者作为对照,2组患者年龄、性别、血型、冷热缺血时间、人类白细胞抗原（HLA）配型、肾病原发病、免疫抑制方案等条件基本匹配。对2组患者间移植肾急性排斥反应（AR）、慢性排斥反应（CR）、移植肾功能延迟恢复（DGF）的发生率以及出院时血肌酐（SCr）水平进行比较。结果肝肾联合移植组AR和DGF发生率均明显低于单独肾移植组,差异有统计学意义（5．6％对33．3％,P= 0．044;0对27．8％,P=0．023）;肝肾移植组CR发生率明显低于单独肾移植组,但差异无统计学意义（0对11．1％,P=0．243）。出院时平均SCr水平肝肾移植组明显低于单独肾移植组,差异有统计学意义[（57．1±6．0）μmol／L对（123．0±11．7）μmol／L,P=0．018）]。结论肝肾联合移植中肝脏对肾脏具有保护作用,能够维持良好的移植肾功能。

Objective To compare the improvement of renal graft function of combined liver-kidney transplantation（CLKT） and kidney alone transplantation（KAT）. Methods The data of 18 CLKT and 18 contralateral kidney alone transplantations were analyzed. The two groups were matched in the following variables： age, gender, blood type, cold and warm iscbemic time of the grafts, human leukocyte antigen （HLA）, primary renal disease, and use of immunosuppressants. Incidences of acute rejection, chronic rejection, delayed graft function and serum creatinine （Cr） on discharge were compared. Results The rates of acute rejection and delayed graft function were much lower inCLKT than those in KAT with significant difference（5. 6% vs 33. 3%,P=0. 044; 0 vs 27.8% P=0. 023）. Chronic rejection incidence was lower in CLKT without significant difference（0 vs 11.1%,P=0.243）. There was much lower Cr lever inCLKT than that in KAT（57.1±6.0 μmol/L vs 123.0 ±11.7 μmol/L, P= 0. 018）. Conclusions Analysis of the data indicates an allograft enhancing perfect effect of liver transplantation on the renal allograft in combined liver- kidney transplantation.