肝肾联合移植术后移植肾功能延迟恢复的原因分析及综合治疗

Causes and systemic therapy for delayed renal function recovery following combined liver-kidney transplantation

目的探讨肝肾联合移植(LKT)术后移植肾功能延迟恢复(DGF)的原因及以持续肾脏替代治疗(CRRT)为基础的综合疗法治疗LKT术后DGF的疗效。方法2001年2月—2005年12月施行LKT的22例患者中,2例术后出现DGF,在日间无肝素连续静脉-静脉血液滤过治疗基础上,进行抗排斥、抗感染和营养支持等治疗。对患者围术期情况及随访结果进行分析。结果本组行LKT的22例患者手术成功率为100%,目前存活17例,受体健康状况及移植物功能良好。仅2例因DGF需CRRT治疗,CRRT治疗过程中无并发症发生,受体健康状况及移植物功能良好,随访至今无乙型病毒性肝炎复发。结论以CRRT为基础的综合疗法能有效治疗LKT术后DGF。

Objectives To investigate the causes of delayed graft （renal） function recovery （DGF） after combined liver-kidney transplantation （LKT） and the effects of systemic therapy based on continuous renal replacement therapy （CRRT）. Methods From January, 2001 to December, 2005, 22 patients underwent corn bined LKT in our centre, and 2 patients presented with DGF after the transplantation for which systemic therapy was administered based on heparin free CRRT supplemented by antirejection and anti-infection therapies and nu trition support. The perioperative condition and findings in follow up observation of the patients were analyzed. Results Combined LKT was performed successfully in all the 22 cases, and 17 patients survived with good host conditions and graft functions. Two patients with DGF after the transplantation received CRRT based systemic therapy, which proved uneventful, and the two patients had good condition and graft function recovery and showed no hepatitis B recurrence during the follow-up. Conclusion Systemic therapy based on CRRT can be effective for management of postoperative DGF in patients undergoing LKT.