肝或肾移植术后受者再次行一期肝肾联合移植三例报告

The clinical experience of simultaneous combined liver-kidney transplantation after liver/kidney transplantation

目的 探讨肝或肾移植术后受者再次行一期肝肾联合移植的手术适应证、术后并发症及存活情况.方法 对2003年10月至2008年12月施行的3例肝或肾移植术后再次行一期肝肾联合移植的受者进行随访,并进行文献复习.对其围手术期死亡率、术后并发症及存活情况进行总结.结果 围手术期死亡率为33.3%（1/3）.术后并发症：1例因腹腔出血术后第29天死于肺部感染、急性移植肾功能衰竭和多器官功能衰竭;3例患者均发生了肺部感染;无急性排斥反应发生.2例存活患者,从首次移植计算,已经分别存活56个月和228个月;从一期肝肾联合移植计算,已经分别存活40个月和48个月.结论 肝肾联合移植是治疗终末期肝肾疾病的有效方法.肝或肾移植术后受者再次行一期肝肾联合移植是可行的.

Objective To investigate the indications, complication and survival of combined liver-kidney transplantation （CLKTs） after liver/kidney transplantation. Methods From Oct. 2003 to Dec. 2008, the clinical data of 3 patients who underwent CLKTs after liver/kidney transplantation were retrospectively followed up and literature was reviewed at our institution. The perioperative mortality, post-operative complications, survival were analyzed. Results The perioperative mortality of patients with CLKTs was 1/3. The postoperative complications： one patient with massive abdominal bleeding died of pulmonary infection, acute renal failure of graft, multiple organ failure on the 29th day after operation; 3 patients with pulmonary infection; no acute rejection of the graft. Two of 3 patients survived 56 months, 228 months from primary transplantation, respectively, while survived 40 months, 48 months from CLKTs, respectively. Conclusion CLKTs is only radical treatment method for patients with end-stage liver disease and end-stage kidney disease. CLKTs after liver/kidney transplantation were feasible.