Davis Connie L
Department of Medicine, Division of Nephrology, University of Washington School of Medicine, Seattle, WA 98195, USA.
Liver Transpl. 2005 Nov(11 Suppl 2):S35-44. doi: 10.1002/lt.20617.
Renal and hepatic function are often intertwined both through the existence of associated primary organ diseases and hemodynamic interrelationships. This connection occasionally results in the chronic failure of both organs, necessitating the need for combined kidney-liver transplantation. Since 1990, over 1,790 patients in the United States have received such transplants with a patient survival somewhat less than that for patients receiving either organ alone. Patients with renal failure due to acute injury or to the hepatorenal syndrome have classically not been included as candidates for combined transplantation due to the reversibility of the renal dysfunction following liver transplantation. However, the rate and duration of renal failure prior to liver transplantation continues to be prolonged even with the new allocation scheme prioritizing liver transplants to those with renal failure. Thus the issue of when kidney transplantation should be offered and what evaluation is necessary prior to the decision continues to confront the transplant community.
肾脏和肝脏功能常常通过相关原发性器官疾病的存在以及血流动力学的相互关系而相互交织。这种联系偶尔会导致两个器官的慢性衰竭，从而需要进行肝肾联合移植。自1990年以来，美国有超过1790名患者接受了此类移植，其患者存活率略低于单独接受任一器官移植的患者。由于肝移植后肾功能障碍具有可逆性，因急性损伤或肝肾综合征导致肾衰竭的患者传统上不被纳入联合移植候选者。然而，即使采用了新的分配方案，将肝移植优先分配给肾衰竭患者，肝移植前肾衰竭的发生率和持续时间仍在延长。因此，何时应提供肾移植以及在做出决定之前需要进行哪些评估的问题，仍然困扰着移植界。
