Latt Nyan L, Alachkar Nada, Taydas Eren, Cameron Andrew, Gurakar Ahmet
Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
Exp Clin Transplant. 2014 Mar;12 Suppl 1:45-9. doi: 10.6002/ect.25liver.l48.
We compared survival outcomes among simultaneous liver-kidney transplants after model for end-stage liver disease (MELD) according to their specific diagnosis and hepatitis C virus versus nonhepatitis C virus.
Clinical data review was performed for all patients who underwent combined liver-kidney transplants at Johns Hopkins Hospital from January 31, 1995, to October 31, 2012. Differences in demographics and characteristics among 2 groups were compared using independent samples t test. Survival analysis and distributions were calculated using Kaplan-Meier and Mantel-Cox log-rank test.
Of 48 combined liver-kidney transplants, 31 simultaneous liver-kidney transplants cases were included; nonsimultaneous liver-kidney transplants and patients with prior transplants were excluded. Proportions of age, sex, ethnicity, pre-MELD score, pretransplant renal replacement therapy requirement, hypertension, diabetes mellitus, and follow-up were similar in both groups. Median follow-up was 30 months. Overall and graft survival rates among simultaneous liver-kidney transplants recipients in the pre-MELD era were significantly superior to simultaneous liver-kidney transplants patients in the post-MELD era (P = .0473). However, overall and graft survival rates among simultaneous liver-kidney transplants recipients who had hepatitis C virus and non-hepatitis C virus causes were not statistically different.
We demonstrated a statistically significant difference in overall and kidney graft survival between the post-MELD era and the pre-MELD era. Subgroup analyses of this group showed no statistically significant difference in overall and kidney-graft survival when compared with their specific diagnosis of hepatitis C virus. This must be further studied and verified in a larger cohort of patients to fully identify the effect of hepatitis C virus infection in this group of patients because it can affect both liver and kidney grafts after transplant.
我们根据终末期肝病模型（MELD）的具体诊断以及丙型肝炎病毒感染与非丙型肝炎病毒感染情况，比较了同期肝肾联合移植受者的生存结局。
对1995年1月31日至2012年10月31日在约翰霍普金斯医院接受肝肾联合移植的所有患者进行临床资料回顾。使用独立样本t检验比较两组患者的人口统计学和特征差异。采用Kaplan-Meier法和Mantel-Cox对数秩检验计算生存分析和分布情况。
在48例肝肾联合移植中，纳入了31例同期肝肾联合移植病例；排除了非同期肝肾联合移植病例和既往有移植史的患者。两组患者在年龄、性别、种族、MELD评分前值、移植前肾脏替代治疗需求、高血压、糖尿病以及随访时间等方面的比例相似。中位随访时间为30个月。MELD评分前时代同期肝肾联合移植受者的总体生存率和移植物生存率显著高于MELD评分后时代的同期肝肾联合移植患者（P = 0.0473）。然而，丙型肝炎病毒感染和非丙型肝炎病毒感染病因的同期肝肾联合移植受者的总体生存率和移植物生存率无统计学差异。
我们证明了MELD评分后时代与MELD评分前时代在总体生存率和肾移植物生存率方面存在统计学显著差异。该组的亚组分析显示，与丙型肝炎病毒的具体诊断相比，总体生存率和肾移植物生存率无统计学显著差异。由于丙型肝炎病毒感染可影响移植后的肝脏和肾脏移植物，因此必须在更大规模的患者队列中进一步研究和验证，以充分确定其在该组患者中的影响。
