Department of Transplant Surgery, Baylor Regional Transplant Institute, Dallas, TX, USA.
Clin Transplant. 2010 Nov-Dec;24(6):807-11. doi: 10.1111/j.1399-0012.2009.01180.x.
The frequency of combined liver and kidney transplants (CLKT) persists despite the pronounced scarcity of organs. In this review, we sought to ascertain any factors that would reduce the use of these limited commodities. Seventy-five adult CLKT were performed over a 23-yr period at our center, 29 (39%) of which occurred during the Model for End-stage Liver Disease (MELD) era. Overall, patient survival rates were 82%, 73%, and 62% at one, three, and five yr, respectively. There was no difference in patient survival based either on pre-transplant hemodialysis status or by glomerular filtration rate (GFR) at the time of transplant. Patients undergoing a second CLKT or a liver retransplantation at the time of CLKT had a survival rate of 30% at three months. In the MELD era, patient survival was unchanged (p = NS) despite an older recipient population (p = 0.0029) and a greater number of hepatitis C patients (p = 0.0428). In summary, patients requiring liver retransplantation with concomitant renal failure should be denied CLKT. Renal allografts may also be spared by implementing strict criteria for renal organ allocation (GFR < 30 mL/min at the time of evaluation) and considering the elimination of preemptive kidney transplantation in CLKT.
尽管器官严重短缺，但联合肝脏和肾脏移植（CLKT）的频率仍然存在。在本综述中，我们试图确定任何可以减少这些有限资源使用的因素。在我们中心的 23 年期间进行了 75 例成人 CLKT，其中 29 例（39%）发生在终末期肝病模型（MELD）时代。总体而言，患者的 1 年、3 年和 5 年生存率分别为 82%、73%和 62%。无论在移植前是否进行血液透析，或者移植时肾小球滤过率（GFR）如何，患者的生存率均无差异。在 CLKT 时进行第二次 CLKT 或肝脏再移植的患者，3 个月时的生存率为 30%。在 MELD 时代，尽管受体人群年龄更大（p = 0.0029），丙型肝炎患者更多（p = 0.0428），但患者的生存率没有变化（p = NS）。总之，对于需要进行肝移植的伴有肾衰竭的患者，应拒绝进行 CLKT。通过实施严格的肾脏器官分配标准（评估时 GFR < 30 mL/min），并考虑在 CLKT 中消除抢先肾移植，也可以节省肾移植。
