Rich Nicole, Tanriover Bekir, Singal Amit G, Marrero Jorge A
1 Digestive and Liver Diseases Division, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.2 Division of Nephrology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.
Transplantation. 2017 Jan;101(1):e12-e19. doi: 10.1097/TP.0000000000001515.
The frequency of simultaneous liver kidney (SLK) transplantation has increased following the implementation of the model for end-stage liver disease system for liver transplantation (LT). There is a paucity of data evaluating SLK outcomes in patients undergoing LT for hepatocellular carcinoma (HCC). Our aim was to compare outcomes between patients with HCC who underwent SLK and those who received SLK for other indications.
We performed a retrospective analysis of adult recipients receiving SLK between 2002 and 2013 from the United Network for Organ Sharing registry. The primary outcome was posttransplant mortality. Patient survival was determined using Kaplan-Meier analysis and predictors of mortality were identified using proportional Cox hazard regression models. Propensity score matching was performed between SLK-HCC and SLK in the absence of HCC (SLK-A) groups to reduce confounding.
Between 2002 and 2013, 186 HCC patients underwent SLK-HCC and 3599 patients underwent SLK-A. The 1-year and 3-year survival rates were 89.0% and 76.7% in the SLK-HCC group and 84.5% and 76.3% in the SLK-A group (P = 0.20). In multivariable Cox regression, HCC was not associated with post-LT survival among all patients (hazard ratio, 1.15; 95% confidence interval, 0.84-1.58) or the propensity score-matched cohort (hazard ratio, 0.97; 95% confidence interval, 0.64-1.47). SLK-HCC patients had similar rates of acute rejection (13.3% vs 10.5%, P = 0.36) and liver graft failure requiring re-transplantation (3.2% vs 2.3%, P = 0.44) compared with SLK-A patients.
Liver transplant candidates with advanced renal dysfunction and HCC may be considered for SLK.
在实施终末期肝病模型（MELD）系统用于肝移植（LT）后，肝肾联合移植（SLK）的频率有所增加。在因肝细胞癌（HCC）接受肝移植的患者中，评估SLK结局的数据较少。我们的目的是比较因HCC接受SLK的患者与因其他适应症接受SLK的患者的结局。
我们对2002年至2013年间从器官共享联合网络登记处接受SLK的成年受者进行了回顾性分析。主要结局是移植后死亡率。使用Kaplan-Meier分析确定患者生存率，并使用比例Cox风险回归模型确定死亡率的预测因素。在SLK-HCC组和无HCC的SLK组（SLK-A）之间进行倾向评分匹配以减少混杂因素。
2002年至2013年间，186例HCC患者接受了SLK-HCC，3599例患者接受了SLK-A。SLK-HCC组的1年和3年生存率分别为89.0%和76.7%，SLK-A组为84.5%和76.3%（P = 0.20）。在多变量Cox回归中，HCC与所有患者LT后的生存率无关（风险比，1.15；95%置信区间，0.84-1.58）或倾向评分匹配队列（风险比，0.97；95%置信区间，0.64-1.47）。与SLK-A患者相比，SLK-HCC患者的急性排斥反应发生率（13.3%对10.5%，P = 0.36）和需要再次移植的肝移植失败率（3.2%对2.3%，P = 0.44）相似。
患有晚期肾功能不全和HCC的肝移植候选者可考虑进行SLK。
