肝肾联合移植的单中心经验总结

Simultaneous liver-kidney transplantation： Single-center study

目的分析单中心肝肾联合移植（SLKT）的治疗效果。方法1999--2010年间共实施SLKT21例，患者的原发疾病分别为多囊病11例，病毒性肝炎后肝硬化合并肝肾综合征5例，慢性肾炎肾功能衰竭合并肝硬化2例，肾移植术后移植肾功能丧失合并肝硬化2例，肝炎后肝硬化合并糖尿病肾病1例。统计患者的资料，与同期同中心“中国肝移植注册网站”收录的肝炎后肝硬化行肝移植的133例（LT组）和“中国肾移植科学登记系统”收录的尸体肾移植609例（KT组）进行对比，分析各组受者术前状态和预后的差异。结果SLKT组术前终末期肝病模型（MELD）评分为21．3±5．5，血肌酐为（516．0±329．9）mmol／L；LT组术前MELD评分为20．6±9．9，血肌酐为（111．4±138．1）mmol／L，与SLKT组相比较，血肌酐的差异有统计学意义（P〈0．01）。SLKT组中，3例分别于术后2周、半年和5年因感染而死亡，1例因多器官功能衰竭而死亡，1例于术后5年自行停药，因排斥反应而死亡。SLKT组术后1年内移植肾急性排斥反应的发生率为零，KT组为60o（P〉0．05）。术后SLKT组移植肾功能延迟恢复的发生率为9．5％，KT组为17．3％（P〉O．05）。SLKT组术后1、3和5年的受者存活率分别为87．7％、67．8％和67．8％，LT组分别为84．2％、73．5％和69．4％（P〉0．05）。结论SLKT是终末期肝、肾疾病的有效、安全的治疗方法。

Objective To analyze the curative effect of simultaneous liver and kidney transplantation （SLKT） for patients with end-stage liver and kidney diseases and liver cirrhosis patients with hepatorenal syndrome. Methods All SLKTs （n = 21 ） performed at our center from January 1999 to December 2010 were reviewed and SLKT outcomes were compared with those of kidney transplantation （KT） （n = 609） and liver transplantation （LT） （n = 133） performed during the same period. Results There were 3 deaths due to infection 2 weeks, 6 months and 5 years respectively after operatioru One patient died due to multiple organ dysfunction syndrome 2 weeks after operation. One patient was dead 5 years after operation because of rejection. MELD level between SLKT and LT had no significant difference, but serum creatinine in SLKT group was significantly higher than in LT group （516.0 ± 329. 9 vs 111.4±138. 1 mmol/L, P〈0. 01）. The 1-year acute kidney rejection rate and rate of delayed graft function （DGF） of the kidney had no significant difference between SLKT group （0 vs 9. 5 %） and KT group （6 % vs 17.3%）. There was no significant difference in one-, 3 and 5-year patient survival rate between SLKT group （87. 7 %, 67. 8 % and 67.8%） and LT group （84. 2 %, 73.5 % and 69. 4 %）. Conclusion SLKT is a safe and effective treatment for end-stage liver and kidney diseases.