肝、肾联合移植与单纯肝移植的比较：系统评价和荟萃分析。
A comparison between combined liver kidney transplants to liver transplants alone: A systematic review and meta-analysis.
机构信息
Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC University Transplant Institute, Rotterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Erasmus MC University Transplant Institute, Rotterdam, the Netherlands.
出版信息
Transplant Rev (Orlando). 2021 Dec;35(4):100633. doi: 10.1016/j.trre.2021.100633. Epub 2021 Jun 1.
BACKGROUND
Since the introduction of the Model for End-stage Liver disease criteria in 2002, more combined liver kidney transplants are performed. Until 2017, no standard allocation policy for combined liver kidney transplant (CLKT) was available and each transplant center decided eligibility for CLKT or liver transplant alone (LTA) on a case-by-case basis. The aim of this systematic review was to compare the clinical outcomes of CLKT compared to LTA in patients with renal dysfunction.
METHODS
Databases were systematically searched for studies published between January 2010 and March 2021. Outcomes were expressed as risk ratios and pooled with a random-effects model. The primary outcome was patient survival.
RESULTS
Four studies were included. No differences were observed for mortality risk at 1 year (risk ratio (RR) 1.03 [confidence interval (CI) 0.97-1.09], 3 years (RR 1.06 [CI 0.99-1.13]) and 5 years (RR 1.08 [CI 0.98-1.19]). The risk of graft loss was similar in the first year (RR 1.10 [CI 0.93-1.30], while 3-year risk of graft loss was significantly lower in CLKT patients (RR 1.15 [CI 1.08-1.24]).
CONCLUSIONS
CLKT has similar short-term graft and patient survival as LTA in patients with renal dysfunction. More data is needed to decide from which KDIGO stage patients benefit the most from CLKT.
背景
自 2002 年引入终末期肝病模型（Model for End-stage Liver disease，MELD）标准以来，更多的联合肝肾移植得以开展。直到 2017 年，联合肝肾移植（combined liver kidney transplant，CLKT）仍没有标准的分配政策，每个移植中心都根据具体情况决定是否进行 CLKT 或单独进行肝移植（liver transplant alone，LTA）。本系统评价的目的是比较肾功能障碍患者接受 CLKT 与 LTA 的临床结局。
方法
系统检索了 2010 年 1 月至 2021 年 3 月间发表的研究。结果以风险比（risk ratio，RR）表示，并采用随机效应模型进行汇总。主要结局为患者生存率。
结果
纳入了 4 项研究。在 1 年（RR 1.03 [97%CI 0.97-1.09]）、3 年（RR 1.06 [99%CI 0.99-1.13]）和 5 年（RR 1.08 [98%CI 0.98-1.19]）时，死亡率风险无差异。在第一年，移植物丢失风险相似（RR 1.10 [93%CI 0.93-1.30]），而在 3 年时，CLKT 患者的移植物丢失风险显著降低（RR 1.15 [98%CI 1.08-1.24]）。
结论
在肾功能障碍患者中，CLKT 的短期移植物和患者生存率与 LTA 相似。需要更多的数据来确定哪些 KDIGO 阶段的患者最受益于 CLKT。
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