Zanus G, Carraro A, Vitale A, Boccagni P, Brolese A, Neri D, Srsen N, Gringeri E, Valmasoni M, D'Amico F, Ciarleglio F A, Violi P, Bonsignore P, Pauletto A, Bassi D, D'Amico F, Burra P, Masier A, Rigotti P, Furian L, Polacco M, D'Amico D F, Cillo U
Department of Surgical and Gastroenterological Science, University of Padova, Padova, Italy.
Transplant Proc. 2007 Jul-Aug;39(6):1933-5. doi: 10.1016/j.transproceed.2007.05.037.
BACKGROUND/AIM: The main indications for combined liver and kidney transplantation (CLKT) are as follows: (1) cirrhosis with renal damage dependent or not upon liver disease, (2) renal failure with dialysis and concomitant liver end-stage disease, (3) congenital diseases, and (4) enzymatic liver deficiency with concomitant renal failure. The aim of this study was to evaluate our results with CLKT both in adult and pediatric patients.
From September 1995 to September 2006, 15 CLKT (2.8%) among 541 liver transplantations included 4 pediatric patients (27%). The main indications for CLKT were hepatitis C virus (HCV) and polycystic diseases in adult patients, and primary hyperoxaluria in pediatric patients.
The double transplantation was performed from the same donor in all cases. All adult patients received whole liver grafts, whereas 3 split transplants and 1 whole liver graft were transplanted in the pediatric patients. Median liver and kidney cold ischemia times were 468 and 675 minutes, respectively. After a median follow-up of 36 months (range, 1-125), the overall survival rate was 80%. Five-year patient and graft survival rates were 100% for adult CLKT, whereas they were 50% for pediatric patients. We observed only 2 cases (18%) of delayed renal function, requiring temporary hemodialysis with progressive graft improvement. There was only 1 case of kidney retransplantation due to early graft nonfunction in a pediatric patient.
Although CLKT is related to major surgical risks, results after transplantation are satisfactory with an evident immunological advantage.
背景/目的：肝肾联合移植（CLKT）的主要适应证如下：（1）伴有依赖或不依赖肝脏疾病的肾损害的肝硬化；（2）接受透析治疗且伴有肝脏终末期疾病的肾衰竭；（3）先天性疾病；（4）伴有肾衰竭的酶性肝缺陷。本研究的目的是评估我们在成人和儿童患者中进行肝肾联合移植的结果。
1995年9月至2006年9月，541例肝移植中有15例（2.8%）为肝肾联合移植，其中包括4例儿童患者（27%）。成人患者肝肾联合移植的主要适应证为丙型肝炎病毒（HCV）感染和多囊性疾病，儿童患者为原发性高草酸尿症。
所有病例均采用来自同一供体的双器官移植。所有成人患者均接受了全肝移植，而儿童患者接受了3例劈离式移植和1例全肝移植。肝脏和肾脏的中位冷缺血时间分别为468分钟和675分钟。中位随访36个月（范围1 - 125个月）后，总体生存率为80%。成人肝肾联合移植患者的5年生存率和移植物生存率均为100%，而儿童患者分别为50%。我们仅观察到2例（18%）肾功能延迟恢复的病例，需要临时血液透析，移植肾功能逐渐改善。仅1例儿童患者因早期移植物无功能而进行了肾脏再次移植。
虽然肝肾联合移植存在重大手术风险，但移植后的结果令人满意，具有明显的免疫优势。
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