CAJ | 학술논문

目的评价肝移植或肝肾联合移植对慢加急性肝功能衰竭(ACLF)伴肾功能不全的治疗效果.方法选择2001年1月到2009年12月133例因ACLF接受肝移植的受者,其中30例受者伴肾功能不全,12例因终末期肾病(ESRD)接受肝肾联合移植,其他18例伴肝肾综合征1型(HRS1)仅接受肝移植.记录分析所有受者的临床数据,并将存活情况进行比较.结果所有受者术前平均终末期肝病模型评分为28,均接受尸体供肝移植,12例肝肾联合移植受者的供肾与供肝来自同一供者.受者院内死亡率为21.8％.不伴肾功能不全和伴肾功能不全受者术后5年存活率分别为72.8％和70％.伴ESRD接受肝肾联合移植受者的治疗效果优于不伴肾功能不全或伴HRS1单纯接受肝移植的受者.结论肝移植能改善大多数ACLF伴HRS1患者的肾功能.肝肾联合移植是治疗ACLF伴ESRD患者的最佳方案,对因肝疾病影响肾功能的患者提供移植肾保护.
목적 평개간이식혹간신연합이식대만가급성간공능쇠갈(ACLF)반신공능불전적치료효과.방법 선택2001년1월도2009년12월133례인ACLF접수간이식적수자,기중30례수자반신공능불전,12례인종말기신병(ESRD)접수간신연합이식,기타18례반간신종합정1형(HRS1)부접수간이식.기록분석소유수자적림상수거,병장존활정황진행비교.결과 소유수자술전평균종말기간병모형평분위28,균접수시체공간이식,12례간신연합이식수자적공신여공간래자동일공자.수자원내사망솔위21.8％.불반신공능불전화반신공능불전수자술후5년존활솔분별위72.8％화70％.반ESRD접수간신연합이식수자적치료효과우우불반신공능불전혹반HRS1단순접수간이식적수자.결론 간이식능개선대다수ACLF반HRS1환자적신공능.간신연합이식시치료ACLF반ESRD환자적최가방안,대인간질병영향신공능적환자제공이식신보호.
Objective To evaluate the outcome of liver transplantation (LT) or combined liver-kidney transplantation (CLKT) for acute-on-chronic liver failure (ACLF) patients with renal dysfunction.Method From January 2001 to December 2009,133 patients underwent LT for ACLF at our center.Among them,30 had both ACLF and renal dysfunction.Of the 30 patients,12 underwent CLKT for end-stage renal disease (ESRD),and the other 18 with hepatorenal syndrome type 1 (HRS1) underwent LT alone.Their clinical data were reviewed and their survival outcomes were compared.Result The median model for end-stage liver disease scores (MELD) of the patients with ACLF were 28.133 patients received deceased donor liver grafts and 12 patients also received the same deceased donor kidney grafts,The hospital mortality rate was 21.8％ for all patients with ACLF.The 5-year survival rates were 72.8％ for patients without renal dysfunction and 70％ for patients with renal dysfunction.The curative effectiveness of the patients with ESRD who underwent CLKT was better than that of the patients without renal dysfunction or the patients with HRS1 who underwent LT alone.Conclusion LT alone improved renal function in most patients with HRS1.Simultaneous liver-kidney transplantation is an excellent strategy in patients with both ACLF and ESRD.It provides protection to kidney allograft in liver-based metabolic diseases affecting the kidney.