Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Transplant Proc. 2021 Jun;53(5):1719-1725. doi: 10.1016/j.transproceed.2021.01.016. Epub 2021 Mar 23.
Most guidelines recommend simultaneous liver-kidney transplantation (SLKT) in patients with liver cirrhosis (LC) and severe chronic kidney disease (CKD) over liver transplantation alone (LTA). CKD, however, is not irreversible. This study evaluates the reversibility of kidney disease after LTA based on kidney size.
In this single-center retrospective study, we classified 90 patients with LC and severe CKD into 3 groups: the normal kidney (NK)-LTA group (n=39), small kidney (SK)-LTA group (both kidneys <9 cm at the time of LTA, n=40), and SK-SLKT group (n=11).
The NK-LTA group had a lower percentage of hepatocellular carcinoma and a higher pre-liver transplantation (LT) estimated glomerular filtration rate. This group, however, was older, received livers from a higher percentage of deceased donors, and had a higher Child-Pugh score. Renal recovery, defined as the return of creatinine to their baseline, or a persistent change from baseline but not persistent (≥3 months) need for renal replacement therapy after LT, was found in 79% in the NK-LTA group, which was higher than 7.5% in the SK-LTA group. Renal and patient survival was found in 56% of the NK-LTA group, which was higher than 2.5% of the SK-LTA group.
There is a high percentage of renal recovery in the NK-LTA group, and accordingly, this does not justify SLKT, since this would result in a "waste" of kidneys. Therefore, KT after LT is recommended over SLKT for the LC patients with NK size.
大多数指南建议，对于肝硬化（LC）合并严重慢性肾脏病（CKD）的患者，应进行肝-肾联合移植（SLKT），而非单纯的肝移植（LTA）。然而，CKD 并非不可逆转。本研究基于肾脏大小，评估了 LTA 后肾脏疾病的可逆性。
在这项单中心回顾性研究中，我们将 90 例 LC 合并严重 CKD 患者分为 3 组：正常肾脏（NK）-LTA 组（n=39）、小肾脏（SK）-LTA 组（LTA 时双侧肾脏<9cm，n=40）和 SK-SLKT 组（n=11）。
NK-LTA 组的肝细胞癌比例较低，肝移植前（LT）估算肾小球滤过率较高。然而，该组患者年龄较大，接受的肝脏来自更高比例的已故供体，且 Child-Pugh 评分更高。肾脏恢复定义为肌酐恢复到基线水平，或 LT 后从基线水平持续变化但不需要持续（≥3 个月）肾脏替代治疗，NK-LTA 组有 79%的患者符合，高于 SK-LTA 组的 7.5%。NK-LTA 组的肾脏和患者存活率分别为 56%，高于 SK-LTA 组的 2.5%。
NK-LTA 组有很高比例的患者出现肾脏恢复，因此，这不能证明 SLKT 合理，因为这将导致“浪费”肾脏。因此，对于 NK 大小的 LC 患者，建议在 LT 后进行 KT，而非 SLKT。
