Doyle M B Majella, Subramanian Vijay, Vachharajani Neeta, Maynard Erin, Shenoy Surendra, Wellen Jason R, Lin Yiing, Chapman William C
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
J Am Coll Surg. 2016 Jul;223(1):193-201. doi: 10.1016/j.jamcollsurg.2016.04.005. Epub 2016 Apr 18.
The decision for a simultaneous liver and kidney transplantation (SLKT) is fraught with controversy. The aim of this study was to compare SLKT with liver transplantation alone (LTA) in patients with pretransplantation renal failure.
A retrospective review comparing patients undergoing SLKT and LTA (with renal failure) between January 2000 and December 2014 was performed.
Of 1,129 liver transplantations, 132 had renal failure pretransplantation; 52 had SLKT and 80 recipients had LTA. Model for End-Stage Liver Disease score and BMI were lower in the SLKT group (p = 0.001). Simultaneous liver and kidney transplantation patients had better overall survival rates at 1 and 5 years compared with LTA (92.3% and 81.6% vs 73.3% and 64.3% respectively; p < 0.01). Graft survival was also superior in patients undergoing SLKT vs LTA. Six of 52 (11.5%) SLKT patients had final positive cross match, but only 1 of 52 (1.9%) kidney grafts was lost to rejection. In the SLKT group, 9 of 52 (17.3%) patients required dialysis post transplantation, but only 2 remained on dialysis beyond 30 days. All patients in the LTA group were on dialysis pretransplantation and significantly more patients (52 of 80 [65%]) required dialysis post LTA (p ≤ 0.0001); 31 of 80 (38.8%) were dialysis dependent for more than 30 days or died on dialysis within 30 days. Two LTA recipients were subsequently listed for kidney transplant.
Patients with end-stage liver disease on dialysis who undergo liver transplantation have significantly better survival when SLKT is performed. In selected patients, SLKT is an appropriate use of a scarce resource, but better prognostic indicators for selection of patients are still needed.
同期肝肾联合移植（SLKT）的决策充满争议。本研究旨在比较SLKT与单纯肝移植（LTA）在移植前肾衰竭患者中的效果。
对2000年1月至2014年12月期间接受SLKT和LTA（伴有肾衰竭）的患者进行回顾性比较研究。
在1129例肝移植患者中，132例移植前存在肾衰竭；52例行SLKT，80例接受LTA。SLKT组的终末期肝病模型评分和体重指数较低（p = 0.001）。与LTA相比，同期肝肾联合移植患者在1年和5年时的总体生存率更高（分别为92.3%和81.6%，而LTA组为73.3%和64.3%；p < 0.01）。SLKT患者的移植物存活率也高于LTA组。52例SLKT患者中有6例（11.5%）最终交叉配型为阳性，但52例肾移植中只有1例（1.9%）因排斥反应失去肾脏。在SLKT组中，52例患者中有9例（17.3%）移植后需要透析，但只有2例在30天后仍需透析。LTA组所有患者移植前均接受透析，且更多患者（80例中的52例[65%]）在LTA后需要透析（p≤0.0001）；80例中有31例（38.8%）依赖透析超过30天或在30天内死于透析。2例LTA受者随后被列入肾移植名单。
接受肝移植的透析终末期肝病患者行SLKT时生存率显著提高。在部分患者中，SLKT是对稀缺资源的合理利用，但仍需要更好的预后指标来选择患者。
