摘要目的 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.

abstractsObjective 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.