肝肾联合移植26例的临床疗效分析

Analysis of clinical efficacy of combined liver and kidney transplantation for 26 patients

目的探讨肝肾联合移植的临床疗效及其影响因素。方法1999年2月至2013年4月单中心开展了26例肝肾联合移植（联合移植组），以同期一般情况相似的35例肝移植（肝移植组）为对照，回顾分析两组生存情况、排斥反应和并发症的发生情况。结果肝移植组术后1、2、5年存活率分别为88．9％、81．3％和69．0％，联合移植组为86．7N、82．1％和65．2％（P〉0．05）。联合移植组中15例受者存活至随访结束，所有移植物功能均正常。联合移植组从2004年之前的经典原位肝移植的手术方式改进为改良背驼式肝移植后，受者的生存情况得到改善。两组术后并发症以感染最为常见。联合移植组发生了3例次肾脏急性排斥反应和1例次肝脏急性排斥反应，治疗后均逆转；肝移植组发生了5例肝脏急性排斥反应，其中1例发展为难治性排斥反应，受者最终死亡。结论在严格掌握适应证、合理把握时机的条件下，肝肾联合移植可获得与肝移植相似的远期疗效。

Objective To analyze the clinical efficacy and its influencing factors of combined liver and kidney transplantation （CLKTx）. Method From February 1999 to April 2013, CLKTx was performed on 26 cases （CLKTx group）, liver transplantation at the same time was performed on 35 cases （liver transplantation group）. The long-term survival, rejection and complications were retrospectively analyzed. Result Fifteen recipients in CLKTx group survived with normal graft function, and the I , 2- and 5-year survival rate was 88.9%, 81.30/40 and 69. 0% respectively. The -, 2- and 5-year survival rate in liver transplantation group was 86. 7%, 82. 1% and 65.2% respectively. There was no significant difference in long-term survival rate between two groups （P 〉 0. 05）. Improvements in the surgical method of liver transplantation could prolong the survival of CLKTx. The most common complication was infection. There were 3 cases of renal acute rejection and 1 case of liver acute rejection in CLKTx group, and 5 cases of liver acute rejection （one case of steroid-resistant rejection） in liver transplantation group. Conclusion CLKTx can achieve a satisfactory long-term effect.