Haad C Rodelo, Rodriguez-Benot A, Martinez-Vaquera S, Navarro-Cabello M D, Aguera-Morales M L, Ruiz de Mier M V Pendon, Montero-Alvarez J L, Mata-Garcia M de la, Briceño-Delgado J, Aljama-Garcia P
Nephrology Department, Reina Sofia University Hospital, Córdoba, Spain.
Transplant Proc. 2013;45(10):3640-3. doi: 10.1016/j.transproceed.2013.10.016.
Renal dysfunction is a common complication of advanced liver failure and liver transplantation. Since the introduction of the MELD criteria the proportion of patients with advanced chronic kidney disease and need for liver transplantation has increased. One alternative is the combined liver-kidney transplant (CLKT). The aim of this study was to evaluate the outcome of this type of transplant in our center.
We retrospectively analyzed all combined simultaneous or sequential transplants from 1989 to 2012. We studied demographic and clinical variables. Survival analysis was performed by Kaplan-Meier method.
In the study period, 1,265 kidney and 1,050 liver transplantations were performed; 34 were CLKT (to 29 adults and 5 children); 13 of these were simultaneous and 12 sequential liver-kidney. We also carried out 4 triple liver-pancreas-kidney transplantations, 3 simultaneous and 1 sequential. The mean age was 44.1 ± 15 years, and 27 were male (93.1%); 9 (37.5%) were diabetic. The main causes of liver disease were viral (n = 11 [41.3%; hepatitis virus B, C, or both] and alcoholism (9 [31%]). The renal disease etiology was unknown in 16 (55.1%), IgA nephropathy in 2 (6.8%), membranoproliferative glomerulonephritis in 2 (6.8%), and calcineurin inhibitor toxicity in 4 (13.6%). Transjugular renal biopsy was performed in 6 sequential transplants. Survival of patients who received a CLKT was excellent: 91%, 51%, and 40%, at 1, 5, and 10 years, respectively. No significant difference was found between sequential and simultaneous transplants (log rank 0.5).
Our results of CLKT show results similar or superior to those of other series and are an alternative to consider in candidates for liver transplantation with chronic kidney disease. Transjugular biopsy is an alternative to study the etiology of renal disease in patients with hepatic dysfunction before or after liver transplantation.
肾功能不全是晚期肝衰竭和肝移植的常见并发症。自引入终末期肝病模型（MELD）标准以来，晚期慢性肾病患者且需要肝移植的比例有所增加。一种替代方案是肝肾联合移植（CLKT）。本研究的目的是评估我院此类移植的结果。
我们回顾性分析了1989年至2012年期间所有同期或序贯联合移植病例。我们研究了人口统计学和临床变量。采用Kaplan-Meier法进行生存分析。
在研究期间，共进行了1265例肾移植和1050例肝移植；34例为肝肾联合移植（29例成人，5例儿童）；其中13例为同期移植，12例为序贯肝肾移植。我们还进行了4例肝-胰-肾三联移植，3例同期移植，1例序贯移植。平均年龄为44.1±15岁，男性27例（93.1%）；9例（37.5%）患有糖尿病。肝病的主要病因是病毒感染（n = 11 [41.3%；乙型肝炎病毒、丙型肝炎病毒或两者兼有]）和酒精中毒（9例 [31%]）。16例（55.1%）肾病病因不明，2例（6.8%）为IgA肾病，2例（6.8%）为膜增生性肾小球肾炎，4例（13.6%）为钙调神经磷酸酶抑制剂毒性。6例序贯移植患者进行了经颈静脉肾活检。接受肝肾联合移植患者的生存率极佳：1年、5年和10年生存率分别为91%、51%和40%。序贯移植和同期移植之间未发现显著差异（对数秩检验P = 0.5）。
我们的肝肾联合移植结果显示与其他系列结果相似或更优，是慢性肾病肝移植候选患者可考虑的替代方案。经颈静脉活检是研究肝移植前后肝功能不全患者肾病病因的一种替代方法。
