同期心肾联合移植11例治疗经验

Experience in the treatment of heart kidney transplantation through non-staged transplant:a report of 11 cases

目的分析心肾联合移植受者的治疗过程及随访结果,总结心肾联合移植的治疗经验。方法2016年10月至2021年5月天津市第一中心医院11例心功能衰竭合并肾功能衰竭患者接受心肾联合移植,男性10例,女性1例,年龄(50.6±12.9)岁,术前体重指数(26.72±3.29)kg/m^(2),术前心功能均为Ⅳ级,左室射血分数(29.40±4.48)%,术前均为尿毒症规律透析状态,透析时间0.5~7.0年,平均2.5年,术前肌酐753.5(434~1144)μmol/L,估算肾小球滤过率5.59(3.93~17.23)ml/(min·1.73m^(2))。手术方案均为同期心肾联合移植,供心和供肾器官均来自同一供者。心脏冷缺血时间为2.75(2.5,4.0)h,肾脏冷缺血时间为9(8.5,15.0)h,心脏移植手术结束至肾移植手术开始时间为2(1.0,3.5)h。长期免疫抑制方案为他克莫司、吗替麦考酚酯和甲泼尼龙联合应用。结果9例术后恢复正常心功能及肾功能,术后半年左室射血分数(57.55±2.51)%,术后半年肌酐107.7(85~132)μmol/L,术后半年24 h尿量1988(1800~2200)ml。随访6~62个月,9例受者均未发生感染及排斥反应等并发症,心功能均为Ⅰ级,生活质量高。术后死亡2例,1例于术后4个月死于肺部毛霉菌感染,另1例于术后1个月死于消化道真菌感染。结论同期心肾联合移植是治疗终末期心脏病合并肾功能衰竭的有效治疗方法。

Objective To explore the treatments and outcomes of heart and kidney transplantation(HKTx)and summarize its management experiences.Methods From October 2016 to October 2020,clinical data,treatment strategies and prognosis of 11 patients received HKTx were analyzed retrospectively.In 11HKTx cases,the ratio of male-to-female was 10∶1,the age(50.6±12.9)years and the preoperative body mass index(26.72±3.29)kg/m^(2).The preoperative cardiac function was class Ⅳ and the preoperative left ventricular ejection fraction(29.40±4.48)%.All patients were in uremic state pre-operation and underwent regular dialysis.The mean duration of dialysis was 2.5(0.5-7.0)years,preoperative creatinine 753.5(434-1144)μmol/L and preoperative predictive glomerular filtration rate 5.59(3.93-17.23)ml/(min preop2).Non-staged transplant was performed and donor heart and kidney were from the same donor.The median time of cold cardiac ischemia 2.75(2.5,4.0)hours,the median time of cold renal ischemia 9(8.5,15.0)hours and the median time from the end of heart transplantation to the beginning of kidney transplantation 2(1.0,3.5)hours.The immunosuppressive regimen was a combination of tacrolimus,mycophenolate mofetil and methylprednisolone.Results Normal cardiac function and renal function normalized in 9 cases.At Month 6 post-operation,the postoperative left ventricular ejection fraction was(57.55±2.51)%,creatinine 107.7(85-132)μmol/L and urine volume in 24h 1988(1800-2200)ml.The long-term survival time was 6-62 months.No such complications as infection or rejection occurred in 9 patients.The cardiac function was classⅠat Month 6 post-operation.One patient died from pulmonary mucor infection at Month 4 post-operation.Another death was due to gastrointestinal fungal infection at Month 1 after HKTx.Conclusions HKTx is an effective treatment for end-stage heart disease with renal failure.