肝肾联合移植13例临床分析

Combined liver-kidney transplantation： a report of 13 cases

目的 探讨肝肾联合移植的适应证、手术并发症及生存情况.方法 回顾性分析2003年10月至2008年12月施行的13例肝肾联合移植患者的临床资料,分析围手术期死亡率、并发症情况及生存情况.结果 13例肝肾联合移植患者围手术期死亡率30.8%（4/13）.术中、术后腹腔出血4例（30.8%）;肺部感染7例（53.8%）;移植肾急性排斥反应1例（7.7%）.本组随访4.4～60个月,中位数40个月.存活1年以上8例,2年以上6例,3年以上5例,4年以上3例,5年以上1例.肝肾联合移植前有1例患者经历肝移植（例2）和2例患者经历肾移植（例3、例4）,例4患者于肝肾联合移植术后第29天死于肺部感染、多器官功能衰竭,例2和例3肝肾联合移植术后分别存活40 m、48 m.结论 肝肾联合移植是治疗终未期肝肾疾病的有效方法.肝/肾移植术后再行肝肾联合移植是可行的.

Objective To investigate the indications, complications and survival results of combined liver-kidney transplantation. Methods From Oct 2003 to Dec 2008, the clinical data of 13 patients who underwent combined liver-kidney transplantation （CLKTs） were retrosptiverly analyzed in our institution. The perioperative mortality rate, complications and the result of follow-up were analyzed.Results The perioperative mortality rate （within 30 days） was 30.8% （4/13）. Postoperative complications included intrabdominal bleeding in 4 patients （ 30. 8% ）; pulmonary infection in 7 patients （53.8%）; acute renal rejection in one （7. 7% ）. Survivors were followed up from 4.4 to 60 months, with the median time of 40 months. Eight patients have survived more than 1 year; six patients have survived more than 2 years; five of them have survived for more than 3 years; and three of them have survived for more than 4 years, with one surviving for more than 5 years. One patient had undergone liver transplantation （ case 2 ） and two patients had had kidney transplantations （ case 3 and case 4 ） before this CLKTs.Postoperatively case 4 died of pulmonary infection and multiple organ failure at day 29, while case 2 and case 4 survived respectively 40 m, 48 m after CLKTs. Conclusions CLKTs is an effective therapy for end-stage liver and kidney disease. CLKTs for patients with irreversible liver and renal insufficiency after initial liver transplantation or kidney transplantation was feasible.