CAJ | 학술논문

目的总结并分析单中心肝肾、胰肾联合移植受者的长期存活情况,探讨不同类型联合移植对移植效果的影响.方法对2001年6月至2010年12月间完成的24例肝肾联合移植和6例胰肾联合移植受者的随访资料进行分析,将联合肾脏移植受者与接受同一供者供肾的单纯肾移植受者的术后第1年移植肾功能及相关指标进行比较.结果 30例受者中位随访时间为82个月.肝肾联合移植受者1、3、5和10年存活率分别为87.5％、79.2％、75.0％和54.2％;胰肾联合移植受者1、3、5和10年存活率分别为100％、100％、100％和66.7％.器官联合移植受者死亡原因分别是心脑血管意外(5例)、感染(3例)、恶性肿瘤(2例)、移植物(肝脏)功能丧失(2例).肝肾联合移植受者与接受同一供者供肾的单纯肾移植受者相比较,联合移植受者在出院时及术后第1年移植肾功能延迟恢复(DGF)发生率、急性排斥反应(AR)发生率、慢性排斥反应(CR)发生率、估算肾小球滤过率(eGFR)与血肌酐均优于后者,差异有统计学意义(均P＜0.05);胰肾联合移植受者与接受同一供者供肾的单纯肾移植受者相比较,上述指标的差异均无统计学意义(P＞0.05).结论器官联合移植是选择性治疗多个脏器同时衰竭的有效方法;供者短缺等因素严重限制了器官联合移植的发展;肝肾联合移植受者中,移植肝脏对同源性移植肾脏具有一定的免疫保护作用;胰肾联合移植受者中,胰腺移植物较肾脏移植物的平均存活时间长.
목적 총결병분석단중심간신、이신연합이식수자적장기존활정황,탐토불동류형연합이식대이식효과적영향.방법 대2001년6월지2010년12월간완성적24례간신연합이식화6례이신연합이식수자적수방자료진행분석,장연합신장이식수자여접수동일공자공신적단순신이식수자적술후제1년이식신공능급상관지표진행비교.결과 30례수자중위수방시간위82개월.간신연합이식수자1、3、5화10년존활솔분별위87.5％、79.2％、75.0％화54.2％;이신연합이식수자1、3、5화10년존활솔분별위100％、100％、100％화66.7％.기관연합이식수자사망원인분별시심뇌혈관의외(5례)、감염(3례)、악성종류(2례)、이식물(간장)공능상실(2례).간신연합이식수자여접수동일공자공신적단순신이식수자상비교,연합이식수자재출원시급술후제1년이식신공능연지회복(DGF)발생솔、급성배척반응(AR)발생솔、만성배척반응(CR)발생솔、고산신소구려과솔(eGFR)여혈기항균우우후자,차이유통계학의의(균P＜0.05);이신연합이식수자여접수동일공자공신적단순신이식수자상비교,상술지표적차이균무통계학의의(P＞0.05).결론 기관연합이식시선택성치료다개장기동시쇠갈적유효방법;공자단결등인소엄중한제료기관연합이식적발전;간신연합이식수자중,이식간장대동원성이식신장구유일정적면역보호작용;이신연합이식수자중,이선이식물교신장이식물적평균존활시간장.
Objective To summarize the long-term outcomes of recipients after combined liverkidney transplantation (CLKT), combined kidney-pancreas transplantation (CKPT), and to evaluate the interactions of transplant grafts.Method The clinical data of 30 recipients who received combined organ transplantation in Nanfang Hospital from June 2001 to December 2010 were retrospectively analyzed, including 24 recipients with CLKT, and 6 with CKPT.Result The median follow-up time was 82 months (7-168 months).The cumulative 1-, 3-, 5-, 10-year patient survival rate of CLKT was 87.5％, 79.2％, 75.0％ and 54.2％, and that of CKPT was 100％, 100％, 100％ and 66.7％,respectively.The causes of death for those combined transplantations were cardio-cerebrovascular diseases (5 cases), infection (3 cases), malignancy (2 cases) and transplanted liver failure (2 cases),respectively.Comparison of the rate of delayed graft failure (DGF), acute rejection (AR), chronic rejection (CR) for the first year post-transplantation and renal graft function (estimated glomerular filtration rate and serum creatinine) of CLKT and isolated kidney transplantation from the same donor at 1st year revealed that all these indexes were superior to the latter with the difference being statistically significant (P ＜ 0.05).But there was no remarkable difference between CKPT and isolated kidney transplant recipients for the above indexes.For 6 cases of CLKT, the mean survival time of pancreatic grafts was longer than kidney grafts.Conclusion Combined organ transplantation is effective for treatment of multiple organ failure diseases.The shortage of donors severely limits the development of multiple organ transplantation.For CLKT recipients, the liver graft has the immuneprotection on the homologous kidney graft.For CKPT recipients, survival time of pancreatic grafts is longer than kidney grafts.