Kim Minjae, Hwang Shin, Ahn Chul-Soo, Moon Deok-Bog, Ha Tae-Yong, Song Gi-Won, Jung Dong-Hwan, Shin Sung, Kim Young Hoon, Ha Hea-Seon, Hong Jung-Ja, Kim In-Ok, Han Duck Jong, Lee Sung-Gyu
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Seoul, Korea.
Division of Kidney and Pancreas Transplantation, Department of Surgery, Seoul, Korea.
Ann Hepatobiliary Pancreat Surg. 2020 Nov 30;24(4):454-459. doi: 10.14701/ahbps.2020.24.4.454.
BACKGROUNDS/AIMS: Simultaneous liver and kidney transplantation (SLKT) has been established as the treatment of choice for patients with concurrent end-stage liver and end-stage kidney diseases. The objective of this study was to analyze the nationwide incidence of SLKT in Korea and the outcomes of SLKT in a high-volume transplant center.
Databases of the Korean Network for Organ Sharing (KONOS) and Asan Medical Center from 2000 to 2019 were retrospectively reviewed to determine the incidence of SLKT.
During 20 years from 2000 to 2019, deceased donor SLKT was performed for 38 cases in the KONOS database. The proportion of deceased donor SLKT was 0.6% (20 of 3333) before adoption of MELD score, which was significantly increased to 1.2% (18 of 1524) after the adoption of MELD score (=0.034). In our institution, there were 11 cases of SLKT (2 cases with deceased donors and 9 cases with living donors). SLKT accounted for 0.2% (11 of 6468) of total liver transplantation volume. During follow-up, five patients died due to hepatocellular carcinoma recurrence (n=2), infection (n=2), or unknown cause (n=1). The 1-year and 10-year overall patient survival rates were 90.9% and 81.8%, respectively.
Results of this study revealed that the incidence of deceased donor SLKT was very low. An increase of such incidence is not anticipated unless the number of deceased donors is markedly increased. Currently, sequential living donor liver transplantation and kidney transplantation with deceased or living donors are mainstays of transplantation rather than SLKT in our institution.
背景/目的：肝肾联合移植（SLKT）已被确立为终末期肝病和终末期肾病并发患者的首选治疗方法。本研究的目的是分析韩国全国范围内SLKT的发生率以及在一个高容量移植中心进行SLKT的结果。
回顾性分析韩国器官共享网络（KONOS）和峨山医疗中心2000年至2019年的数据库，以确定SLKT的发生率。
在2000年至2019年的20年间，KONOS数据库中进行了38例尸体供体SLKT。在采用终末期肝病模型（MELD）评分之前，尸体供体SLKT的比例为0.6%（3333例中的20例），在采用MELD评分后显著增加至1.2%（1524例中的18例）（P=0.034）。在我们的机构中，有11例SLKT（2例尸体供体和9例活体供体）。SLKT占肝移植总量的0.2%（6468例中的11例）。在随访期间，5例患者因肝细胞癌复发（n=2）、感染（n=2）或不明原因（n=1）死亡。患者1年和10年的总生存率分别为90.9%和81.8%。
本研究结果显示尸体供体SLKT的发生率非常低。除非尸体供体数量显著增加，否则预计这种发生率不会增加。目前，在我们机构中，序贯活体供肝移植以及尸体或活体供肾移植是移植的主要方式，而非SLKT。
