复杂终末期肝肾病肝肾联合移植术1例报道

Combined liver-kidney transplantation in patients with complicate end stage of liver-kidney disease:one case report

目的 总结并探讨肝肾联合移植的手术技术、临床治疗经验及疗效。方法 患者因多囊肝并门脉主干先天性狭窄畸形、双侧多囊肾及乙型肝炎后肝硬化、反复发作性肝性脑病 ,并伴有慢性肾功能衰竭而施行一期肝肾联合移植。供、受体血型不一致但相匹配 (O型 -B型 )。肝移植采用经典的原位肝移植技术 ,肾移植采用常规方法。术前 1h及术后 14d给予Daclizumab行免疫诱导治疗 ,术后免疫抑制治疗包括FK5 0 6、霉酚酸酯 (MMF)及激素。分别于术前 60d和术后 7d开始服用抗乙肝病毒药 (贺普丁、Laminvudine) ,并肌注乙肝免疫球蛋白 (HBIg)。结果 受者术后无手术并发症发生 ,移植肝、肾功能恢复良好 ,乙型肝炎再感染被控制 ,现已术后近 10个月。结论 完善的手术技巧、围手术期的严密监测及并发症的及时正确处理等是肝肾联合移植成功的重要条件 ;ABO血型不一致但符合输血原则的供受体间进行肝或肝肾联合移植可以取得良好的临床治疗效果 ;Daclizumab的免疫诱导加以FK5 0 6为主的三联治疗免疫抑制效果良好 ;

Purpose: To invesagate the surgical techniques, clinical experiences and therapeutic effects of combined liver-kidney transplantation(CLKT). Methods: Combined liver-kidney transplantauˆon was performed on one patient with liver, cirrhosis and hepatic enoephalopathy of hepatitis B and uremia of chronic nephritis complicated with milticapsular liver, bilateral kidney and portal vein stenosis. ABO blood type incompatible but matched (group O-to-B) cadavetic allografts were used in the CLKT. Liver and kidney transplantation was carried out by using orthotopic and ordinary methods respectively. The humanized mAb Daclizumab(Zenapax) was given to recipient as immuned induction treatment at preoperative one hour and postoperative 14 days respectively. Baseline immunosuppressive drugs consisted of FK506, mycophenolate mofetil(MMF) and corticosteroid. Lamividine was used on day 60 preoperation and day 7 postoperation respectively. In the meantime hepatitis B immunoglobin (HBIg) was injected musclely. Results: The complications included acute and chronic rejection has not been taken placed sinoe the transplantation day. Both transplant organs had rapidly normal functions postoperation, without primary nonfunction of liver graft happened. The patients has been survived for 10 months with normal life quality. Conclusions: Skilled operation techniques, comprehensive monitoring perioperatively and correct management are all major factors for success. ABO blood type incompatible but matched(group O-to-B) cadaveric CLKT can be performed safely. The induction treatment of Zenapax and baseline immunosuppression consisted of FK506, MMF and cortiocosteroid are effective and safe. Combination therapies of Lamividine and HBIg to prevent HBV recurrence may be more effective.