Department of Medicine, Dalhousie University, Halifax, NS, Canada.
Transplantation. 2011 Jan 15;91(1):121-7. doi: 10.1097/tp.0b013e3181fcc943.
The use of simultaneous liver kidney transplantation has increased dramatically. When the liver and kidney are available from the same deceased donor, what is the best decision? There are two allocation options. In the combined allocation, both organs are allocated to a liver failure (end-stage liver disease [ESLD]) patient on dialysis leaving an end-stage renal disease (ESRD) patient on dialysis. In split allocation, the liver is allocated to the liver failure patient on dialysis and the kidney to the patient with ESRD.
A computerized medical decision analysis was performed using published US survival data. The two options were compared by examining differences in projected quality-adjusted life years (QALYs).
Combined allocation was the best strategy (+0.806 QALYs) if liver transplant recipients on dialysis have proportionately worse survival compared with kidney failure alone patients on dialysis. However, because some patients with hepatorenal syndrome recover kidney function post-liver transplant alone (LTA), a second analysis incorporated the possibilities of being dialysis free. If the chance of recovery of renal function is 50% rather than 0%, the decision reversed. Here, the split allocation provided 1.02 more total QALYs than the combined allocation.
This study demonstrates that simultaneous liver kidney transplantation is an excellent strategy in most patients with both ESLD and ESRD. However, allocating a kidney to a patient with ESLD, who has the potential to be dialysis free without a kidney transplant, does not maximize overall outcomes when all patients are considered.
同期肝肾移植的应用显著增加。当肝和肾来自同一个已故供者时，最佳决策是什么？有两种分配方案。在联合分配中，两个器官都分配给接受透析治疗的肝衰竭（终末期肝病[ESLD]）患者，而将接受透析治疗的终末期肾病（ESRD）患者留下。在分割分配中，肝脏分配给肝衰竭透析患者，肾脏分配给 ESRD 患者。
使用已发表的美国生存数据进行计算机医学决策分析。通过检查预期质量调整生命年（QALYs）的差异来比较两种选择。
如果接受透析治疗的肝移植患者的生存状况与单独患有肾衰竭的透析患者相比相对较差，那么联合分配是最佳策略（+0.806 QALYs）。然而，由于一些肝肾功能衰竭患者在单独进行肝移植后会恢复肾功能（LTA），因此第二次分析纳入了肾功能恢复的可能性。如果肾功能恢复的机会为 50%而不是 0%，则决策反转。在这里，分割分配比联合分配提供了 1.02 更多的总 QALYs。
本研究表明，同期肝肾移植在大多数同时患有 ESLD 和 ESRD 的患者中是一种极好的策略。然而，当所有患者都被考虑在内时，将肾脏分配给有机会在不进行肾移植的情况下无透析的 ESLD 患者，并不会使总体结果最大化。
