肝肾联合移植二例报告

Simultaneous hepatorenal transplantation: two cases report

目的 探讨肝肾联合移植的手术技术、治疗经验及疗效。方法 给２ 例肝炎后肝硬变、肝功能不全合并慢性肾功能衰竭患者施行一期肝肾联合移植。供体器官采用ＵＷ 液原位灌洗， 快速联合切取。肝移植采用原位肝移植技术， 肾移植采用常规方法。术后免疫抑制治疗采用环孢素Ａ、霉酚酸酯、抗淋巴细胞球蛋白和激素联合应用。分别于术后５０ ｄ 和４０ ｄ 开始服用抗乙型肝炎病毒药物拉米呋啶。结果 例１ 移植器官立即发挥功能， 术后１１０ ｄ 移植肾发生轻度不典型排斥， 用甲泼尼龙冲击后控制。例２ 术后供肝立即发挥功能， 但先后并发急性肾功能衰竭、精神症状、脑血栓、骨髓抑制和移植肝慢性轻度排斥， 分别给予相应治疗后控制。目前２ 例移植肝、肾功能正常， 未发现移植肝乙型肝炎病毒再感染， 已分别存活１３０ ｄ 和９０ ｄ。结论 肝肾联合移植是治疗肝肾功能同时不全的途径之一， 单纯的肝移植或肾移植均不能为此类患者提供帮助； 肝肾联合移植较单纯的肝移植在技术与管理上要求更高。

Objectives To investigate the surgical techniques, clinical experiences and therapeutic effects of simultaneous hepatorenal transplantation. Methods Simultaneous hepatorenal transplantation was performed on one patient with liver cirrhosis of hepatitis B and uremia of chronic nephritis and one with liver cirrhosis of hepatitis B complicated with hepatorenal syndrome. Infusion in situ of the donors' organs was carried out by UW solution and multiple organs were harvested. Liver and kidney transplantation was carried out by using orthotopic and ordinary methods respectively. Immunosuppressive drugs consisted of cyclosporine, mycophenolate mofetil, ALG and corticosteroid. Lamividine was used on day 50 and day 40 postoperation respectively. Results Both transplant organs had rapidly normal functions postoperation, and the patient recovered well but suffered from mild kidney rejection on the 110 postoperative day in case 1. In case 2, acute renal function failure, mental symptoms, muscle spasm, cerebral artery thrombosis, inhale pneumonia and chronic liver graft rejection ensued sequentially but passed at over the end. The patients have been survived for 4 and 3 months respectively with normal life quality. Conclusions Combined hepatorenal transplant is one of the treatment methods for liver and kidney function failure but requiring more comprehensive techniques than single organ transplant which can't bring satisfactory results to the patients.