肝肾联合移植15例报道

目的探讨肝肾联合移植的适应证和疗效。方法对2001年2月至2003年12月施行肝肾联合移植术的15例患者进行了随访。15例中,乙型肝炎后肝硬化合并肝肾综合征8例、合并尿毒症2例、合并糖尿病肾病1例;多囊肝和多囊肾2例;Caroli病合并多囊肾1例;酒精性肝硬化合并尿毒症1例。对肝肾联合移植患者的手术方式,围手术期并发症,术后急、慢性排斥反应和乙型肝炎复发情况及随访结果进行了分析。结果15例肝肾联合移植术后移植物功能均恢复良好,6个月和1年生存率为100%。1例术前有严重营养不良者,术后给与48d的呼吸机支持后康复。术后创面出血和消化道出血各1例,经非手术治疗后治愈。胆道吻合口狭窄1例,用内镜下球囊扩张术治愈。1例术后2周发生急性移植肝排斥反应,给予激素冲击治疗后得到控制。1例术后30个月时因停用拉米夫定后乙型肝炎复发死于移植肝功能丧失。结论肝肾联合移植是终末期肝病合并慢性肾功能衰竭或肾功能损害的安全有效方法。对乙型肝炎患者术后尽早应用拉米夫定和乙型肝炎病毒免疫球蛋白预防肝炎复发。

Report of 15 cases of combined liver-kidney transplantation

Objective To investigate the indications and results of combined liver-kidney transplantation.Methods From Jan. 2001 to Dec. 2003, 15 patients were subjected to combined liver-kidney transplantation in our department. The underlying diseases included hepatitis B viral cirrhosis complicated by HRS ( n= 8), hepatitis B viral cirrhosis complicated by uremia ( n =2), hepatitis B viral cirrhosis complicated by diabetic nephropathy ( n =1), polycystic liver and kidney disease ( n =2), Caroli's disease and polycystic kidney ( n =1), alcoholic liver cirrhosis complicated by uremia ( n =1). The surgical procedure, perioperative complications, acute and chronic rejection, the recurrence of hepatic viral B hepatitis, and the result of follow-up were analyzed.Results The graft function in 15 cases of combined liver-kidney transplantation was restored well after operation. The 6-month and one-year survival rate was 100%. One patient was supported by respiration machine for 48 days. The complications occurred in 3 patients after operation, including one case of gastroenternal bleeding repeatedly and one case of postoperative wound bleeding subject to non-surgical treatment, and one case of stenosis of biliary anastomosis subject to ERCP. Only one patient experienced a rejection episode of the liver. No acute rejection of the kidney graft occurred. One patient was died from liver graft function failure by recurrence of hepatitis B after 30 months.Conclusions Combined liver-kidney transplantation is only radical treatment method for patients with end-stage liver disease with chronic renal dysfunction or chronic renal failure. In the patients with hepatitis B,lamividine and hepatitis B immunoglobin can prevent the recurrence of hepatitis B.