Combined liver-kidney transplantation: experience at a brazilian university hospital

Background: Combined liver-kidney transplant is a routine procedure in many transplant centers. The increase in its number coincided with the introduction in 2002 of the MELD (Model for End-stage Liver Disease) score for allocation of livers, prioritizing patients with renal dysfunction. Aim : To analyze the experience with combined liver-kidney transplantation in a liver transplant center in Brazil. Method : A retrospective review was conducted. All transplants were performed using grafts from deceased donors. Results : Sixteen combined liver-kidney transplantations were performed in the same period, which corresponds to 2.7% and 2.5% of the kidney and liver transplants, respectively. Fourteen patients were male (87.5 %) and two were female (12.5%). The average patients and donors age was 57.3±9.1 and 32.7±13.1, respectively. The MELD score mean was 23.6±3.67. The main cause of liver dysfunction were chronic hepatitis C virus (n=9). As for renal dysfunction, diabetic nephropathy (n=4) was the most frequent. There were six deaths, two of them by severe dysfunction of the liver graft and four by infectious causes. The 1, 3 and 5 years survival rate in patients undergoing liver-kidney transplantations was 68.8%, 57.3% and 57.3%, respectively. Conclusion : The survival rates achieved in this series are considered satisfactory and show that this procedure has an acceptable morbidity and survival.

背景：肝肾联合移植在诸多移植中心已成为常规手术方式。该术式的开展例数增长与2002年终末期肝病模型（Model for End-stage Liver Disease，MELD）评分用于肝脏分配体系的推行同步，该分配体系优先纳入肾功能不全患者。目的：分析巴西某肝移植中心开展肝肾联合移植的临床经验。方法：本研究采用回顾性分析方法，所有移植手术均使用已故供者的移植物完成。结果：同期共完成16例肝肾联合移植手术，分别占同期肾脏移植总量与肝脏移植总量的2.7%与2.5%。其中14例患者为男性（占比87.5%），2例为女性（占比12.5%）。患者与供者的平均年龄分别为57.3±9.1岁与32.7±13.1岁。受试者的平均MELD评分为23.6±3.67。肝功能不全的主要病因是慢性丙型肝炎病毒感染（n=9）；肾功能不全的最常见诱因为糖尿病肾病（n=4）。本研究中共出现6例死亡病例，其中2例死于肝移植物严重功能障碍，4例死于感染性并发症。接受肝肾联合移植的患者1年、3年及5年生存率分别为68.8%、57.3%与57.3%。结论：本队列研究获得的生存率数据令人满意，表明该术式具有可接受的并发症发生率与预后生存情况。