Demirci Gülçin, Becker Thomas, Nyibata Miguel, Lueck Rainer, Bektas Hueseyin, Lehner Frank, Tusch Günter, Strassburg Christian, Schwarz Anke, Klempnauer Juergen, Nashan Bjoern
Klinik fuer Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
Liver Transpl. 2003 Oct;9(10):1067-78. doi: 10.1053/jlts.2003.50210.
Experience with combined liver-kidney transplantation (L-KTx) has increased, but controversy regarding this procedure continues because the indications are not clearly defined yet. Between 1984 and 2000, 38 patients underwent simultaneous L-KTx and 9 patients underwent sequential transplantation, receiving either a liver before a kidney or a kidney before a liver. Main indications for a simultaneous procedure were polycystic liver-kidney disease with cirrhosis and coincidental renal failure. The main indications for sequential procedure were cirrhosis caused by viral infection for the liver and glomerulonephritis for the kidneys. Outcomes in these patients were evaluated retrospectively. Regarding simultaneous transplantation, 28 (73.7%) long-term survivors were followed up for 0.7 to 12.5 years. Currently, 24 (63.2%) patients are alive with good liver function. Fourteen patients died; 10 patients died in the early postoperative phase because of septic complications, and most of them were cirrhotic with a poor preoperative clinical status. Currently, 2 of the surviving patients (8%) have returned to dialysis, 4 (17%) have reduced renal function, and 18 (75%) have good renal function. Five liver and 2 kidney retransplantations were performed during the follow-up. In cases of sequential grafting, patients undergoing kidney transplantation in the presence of a previously transplanted stable liver did better than those who underwent liver transplantation after kidney transplantation. When liver transplantation was performed early and electively before substantial worsening, combined L-KTx is a safe procedure offering excellent long-term palliation.
肝肾联合移植（L-KTx）的经验有所增加，但由于该手术的适应证尚未明确界定，围绕此手术的争议仍在继续。1984年至2000年期间，38例患者接受了同期L-KTx，9例患者接受了序贯移植，即先接受肝脏移植再接受肾脏移植或先接受肾脏移植再接受肝脏移植。同期手术的主要适应证是伴有肝硬化和并发肾衰竭的多囊肝肾疾病。序贯手术的主要适应证是肝脏由病毒感染引起的肝硬化以及肾脏的肾小球肾炎。对这些患者的预后进行了回顾性评估。关于同期移植，28例（73.7%）长期存活者接受了0.7至12.5年的随访。目前，24例（63.2%）患者存活且肝功能良好。14例患者死亡；10例患者在术后早期因感染并发症死亡，其中大多数为肝硬化患者且术前临床状态较差。目前，存活患者中有2例（8%）恢复了透析，4例（17%）肾功能减退，18例（75%）肾功能良好。随访期间进行了5例肝脏和2例肾脏再次移植。在序贯移植的情况下，在先前移植的稳定肝脏存在的情况下接受肾脏移植的患者比在肾脏移植后接受肝脏移植的患者情况更好。当在实质性恶化之前早期且选择性地进行肝脏移植时，肝肾联合移植是一种安全的手术，可提供出色的长期缓解效果。
