肝肾联合移植术中肝脏对肾脏的保护作用

A preliminary observation of liver graft's protective effects for kidney graft in combined liver-kidney transplantation

目的 :探讨肝肾联合移植术中肝脏对肾脏的保护作用。方法 :给 1例肾移植术后移植肾失功并肝炎后肝硬化患者先行丧失功能移植肾切除术 ,术后第 5天始每天口服环磷酰胺 5 0mg ,连服 3个半月。经两次血浆置换 ,群体反应抗体 (PRA)由 6 6 %降至 2 2 .5 % ,施行一期肝肾联合移植。供肝血流开放前及开放后每间隔半小时动态检测PRA ,共 7次 ,术后 1个月、3个月、9个月复查PRA。术后免疫抑制治疗采用FK5 0 6、霉酚酸酯 (MMF)和激素联合应用。结果 :术后供肝、肾立即发挥功能 ,肝动静脉血流开放后 ,PRA由 2 2 .5 %降至5 % ,并维持在 7.5 % (见图 1) ,术后未发生排斥反应现象。随访 9个月 ,移植肝、肾功能正常 ,术后 1个月、3个月、9个月复查PRA分别为 7.5 %、8.33%和 7.5 %。结论 :肝肾联合移植术中肝脏对肾脏有一定的保护作用。

Objective:To explore whether the liver graft has protective effects for the kidney graft when transplanted simultaneously from the same donor.Methods:A patient with failure renal graft function complicated with cirrhosis was resected of renal graft. Daily dose of 50 mg CTX was given 5 days after operation and continued for three and half months. After two courses of plasma exchange,PRA was reduced from 66% to 22.5%. Combined kidney and liver transplantation were performed simultaneously,PRA was monitored every half hour after liver reperfusion,postoperative immunosuppressive therapy consisted of FK506,MMF,and steroids.Results:The kidney and liver grafts functioned normally after transplantation. PRA reduced from 22.5% to 5% and maintained 7.5%. Kidney and liver grafts functioned well and PRA was about 8.33% or so in nine months of follow up.Conclusion:Liver graft has protective effects for kidney graft from the same donor in combined liver and kidney transplantation.