背景:根据一些小型研究,指南推荐在代偿性肝硬化中单独进行肾脏移植(KTA),但这并不广泛进行,尽管它对患者和器官供应有潜在的好处。我们的目的是确定KTA在代偿性肝硬化患者中的预后。
方法:从2012年1月12日至2021年,对患有代偿性肝硬化的KTA受者的结局与患有慢性肝病(CLD)但没有肝硬化的患者进行回顾性比较。还将代偿性肝硬化患者与匹配的队列进行了比较(基于年龄,血液透析时间,性别,和种族)没有CLD的KTA接受者。结果包括患者生存率,同种异体移植失败,同种异体移植排斥,严重感染,肝脏代偿失调,和停留时间(LOS)。
结果:超过9年,执行了1562次KTA,150(9.6%)患者患有CLD,主要是由于慢性丙型肝炎,中位随访时间为3.5年。32/150(21%)在KTA时具有代偿性肝硬化,平均MELD-Na为22(1.5)。鉴定了匹配的对照(n=189)。我们发现患者生存率没有差异(p=0.07),同种异体移植失败(p=.6),同种异体移植排斥(p=0.43),严重感染率(p=0.31),以及LOS(p=.61)在代偿期肝硬化患者与CLD但无肝硬化患者相比,但肝脏失代偿率较高(p=.004)。同样,与没有CLD的患者相比,肝硬化患者的生存率相似(p=.20),同种异体移植失败(p=0.27),同种异体移植排斥反应(p=.62)和LOS(p=.19),但严重感染率较高(p=.001)。
结论:我们的研究支持KTA在代偿期肝硬化患者中的安全性和有效性。
Guidelines recommend kidney transplant alone (KTA) in compensated cirrhosis based on a few small studies, but this is not widely performed despite its potential benefit to patients and the organ supply. Our aim was to determine the outcomes of KTA in patients with compensated cirrhosis.
From 1/2012 to 12/2021, outcomes in KTA recipients with compensated cirrhosis were retrospectively compared to patients with chronic liver disease (CLD) but no cirrhosis. Patients with compensated cirrhosis were also compared to a matched cohort (based on age, time on hemodialysis, sex, and ethnicity) of KTA recipients without CLD. The outcomes included patient survival, allograft failure, allograft rejection, serious infection, liver decompensation, and length of stay (LOS).
Over 9 years, 1562 KTAs were performed, with 150 (9.6%) patients having CLD mostly due to chronic hepatitis C, and a median follow-up of 3.5 years. 32/150 (21%) had compensated cirrhosis at the time of KTA with a mean MELD-Na of 22 (1.5). Matched controls (n = 189) were identified. We found no differences in patient survival (p = .07), allograft failure (p = .6), allograft rejection (p = .43), rates of serious infection (p = .31), as well as LOS (p = .61) among patients with compensated cirrhosis compared to patients with CLD but no cirrhosis, but with higher rates of liver decompensation (p = .004). Similarly, compared to patients without CLD, patients with cirrhosis had similar rates of patient survival (p = .20), allograft failure (p = .27), allograft rejection (p = .62) and LOS (p = .19) but with higher rates of serious infections (p = .001).
Our study supports the safety and efficacy of KTA in patients with compensated cirrhosis.