Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico.
Int J Surg. 2020 Oct;82S:149-154. doi: 10.1016/j.ijsu.2020.02.008. Epub 2020 Feb 19.
Combined liver-kidney transplantation is a life-saving procedure for patients with end-stage liver disease and underlying chronic kidney disease, or prolonged acute kidney injury. Due to physiologic changes secondary to portal hypertension in patients with end-stage liver disease, kidney injury is common, and combined liver-kidney transplantation accounts for 10% of all the liver transplants performed in the United States. Recently implemented policy in the United States standardizes the medical criteria for eligibility, and introduces a 'safety net' for those who are transplanted with a liver graft alone, in order to be able to receive a kidney graft later. Increasing number of combined liver-kidney transplants provides a large cohort of patients to be studied in detail for identification of factors (both donor and recipient-related) associated with better outcomes. Data regarding the safety and efficacy of delaying the kidney transplant part of the combined liver-kidney transplantation, and the immunologic benefits of the multi-organ transplantations including the liver are emerging. Here, we review the most recent analyses, and provide our opinion regarding the best practices in combined liver-kidney transplantation based on the evidence.
肝肾联合移植是治疗终末期肝病伴慢性肾脏病或急性肾损伤延长的患者的一种挽救生命的方法。由于终末期肝病患者门脉高压引起的生理变化，肾脏损伤很常见，肝肾联合移植占美国所有肝移植的 10%。美国最近实施的政策使资格的医学标准标准化，并为仅接受肝移植物移植的患者提供了“安全网”，以便以后能够接受肾移植物。越来越多的肝肾联合移植为详细研究确定与更好结果相关的因素（供体和受体相关）提供了大量患者队列。关于延迟肝肾联合移植中肾移植部分的安全性和有效性的数据，以及包括肝脏在内的多器官移植的免疫益处正在出现。在这里，我们回顾了最近的分析，并根据证据就肝肾联合移植的最佳实践提出了我们的看法。
