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心脏和肾脏联合移植:合适的手术顺序是什么?

Combined heart and kidney transplantation: what is the appropriate surgical sequence?

作者信息

Ruzza Andrea, Czer Lawrence S C, Trento Alfredo, Esmailian Fardad

机构信息

Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.

出版信息

Interact Cardiovasc Thorac Surg. 2013 Aug;17(2):416-8. doi: 10.1093/icvts/ivt172. Epub 2013 Apr 24.

DOI:10.1093/icvts/ivt172
PMID:23615433
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3715178/
Abstract

Combined heart and kidney transplantation is increasing in frequency but there are no guidelines to establish the indications, contraindications and sequence for this surgical procedure. We report our single-centre experience on 30 consecutive patients who underwent combined heart and kidney transplant in comparison with heart transplant alone. Patients had similar preoperative characteristics in both groups. Combined heart and kidney transplant is associated with the same long-term survival rate, low cellular rejection and antibody-mediated rejection rates when compared with heart transplant alone. We did not observe any difference in the outcomes related to preoperative patient characteristics. We suggest the staged surgical approach as the preferred method for transplant.

摘要

心脏和肾脏联合移植的频率正在增加,但对于该手术的适应证、禁忌证及手术顺序尚无指导原则。我们报告了连续30例接受心脏和肾脏联合移植患者的单中心经验,并与单纯心脏移植患者进行了比较。两组患者术前特征相似。与单纯心脏移植相比,心脏和肾脏联合移植的长期生存率、细胞性排斥反应及抗体介导的排斥反应发生率相同。我们未观察到术前患者特征对预后有任何差异。我们建议采用分期手术方法作为移植的首选方法。

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Combined heart and kidney transplantation: what is the appropriate surgical sequence?心脏和肾脏联合移植:合适的手术顺序是什么?
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Evolutions in Combined Heart-Kidney Transplant.心脏-肾脏联合移植的演变。
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本文引用的文献

1
Survival and allograft rejection rates after combined heart and kidney transplantation in comparison with heart transplantation alone.与单纯心脏移植相比,心脏和肾脏联合移植后的生存率及同种异体移植排斥率。
Transplant Proc. 2011 Dec;43(10):3869-76. doi: 10.1016/j.transproceed.2011.08.095.
2
Heart transplantation in patients aged 70 years and older: a two-decade experience.70岁及以上患者的心脏移植:二十年经验
Transplant Proc. 2011 Dec;43(10):3851-6. doi: 10.1016/j.transproceed.2011.08.086.
3
Natural course and risk factors for impaired renal function during the first year after heart transplantation.心脏移植后第一年肾功能受损的自然病程和危险因素。
J Heart Lung Transplant. 2010 Jun;29(6):633-40. doi: 10.1016/j.healun.2010.01.004. Epub 2010 Mar 29.
4
Pretransplantation patient characteristics and survival following combined heart and kidney transplantation: an analysis of the United Network for Organ Sharing Database.心脏和肾脏联合移植术前患者特征及生存情况:器官共享联合网络数据库分析
Arch Surg. 2009 Mar;144(3):241-6. doi: 10.1001/archsurg.2008.559.
5
Induction therapy with thymoglobulin after heart transplantation: impact of therapy duration on lymphocyte depletion and recovery, rejection, and cytomegalovirus infection rates.
J Heart Lung Transplant. 2008 Oct;27(10):1115-21. doi: 10.1016/j.healun.2008.07.002.
6
Regulatory T cells generated by the kidney may mediate the beneficial immune effects of combining kidney with heart transplantation.
Surgery. 2004 May;135(5):473-8. doi: 10.1016/j.surg.2004.02.009.
7
And hemolysis goes on: ventricular assist device in combination with veno-venous hemofiltration.并且溶血仍在继续:心室辅助装置联合静脉-静脉血液滤过。
Ann Thorac Surg. 2002 Feb;73(2):546-8. doi: 10.1016/s0003-4975(01)03326-4.
8
An overview of combined heart and kidney transplantation.心脏与肾脏联合移植概述。
Curr Opin Cardiol. 1999 Mar;14(2):121-5. doi: 10.1097/00001573-199903000-00008.
9
Total support of the circulation of a patient with post-cardiotomy stone-heart syndrome by a partial artificial heart (ALVAD) for 5 days followed by heart and kidney transplantation.使用部分人工心脏(辅助左心室辅助装置)对心脏术后石心综合征患者的循环进行全面支持5天,随后进行心脏和肾脏移植。
Lancet. 1978 May 27;1(8074):1125-7. doi: 10.1016/s0140-6736(78)90301-x.