摘要目的 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.

abstractsObjective 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.