RESUMO
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.
Assuntos
Transplante de Fígado , Adulto , Brasil , Feminino , Hospitais Universitários , Humanos , Transplante de Rim/métodos , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
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. .
Racional: O transplante combinado fígado-rim é procedimento de rotina em muitos centros de transplante. O aumento no seu número coincidiu com a introdução em 2002 do escore MELD (Model for End-stage Liver Disease) para alocar fígados, priorizando pacientes com disfunção renal. Objetivo : Mostrar a experiência em transplante combinado fígado-rim de um centro de transplante hepático. Método : Foi realizado estudo retrospectivo de pacientes adultos tratados com transplante combinado fígado-rim. Todos foram feitos com enxertos de doadores cadáveres. Resultados : Dezesseis transplantes combinados fígado-rim foram realizados no período, correspondendo a 2,7% e 2,5% dos transplantes de rim e fígado, respectivamente. Quatorze eram homens (87,5%) e duas mulheres (12,5%). A média de idade dos pacientes e doadores foi 57,3±9,1 e 32,7±13,1, respectivamente. A média do escore MELD foi 23.6±3.67. A principal causa de disfunção hepática foi hepatite crônica pelo vírus C (n=9). Para a disfunção renal, nefropatia diabética (n=4) foi a mais frequente. Houve seis mortes, duas por disfunção grave do enxerto hepático e quatro por causas infecciosas. A taxa de sobrevida dos pacientes submetidos ao transplante combinado fígado-rim no 1º, 3º e 5º anos foi 68.8%, 57.3% e 57.3%, respectivamente. Conclusão : As taxas de sobrevida alcançadas nesta série são consideradas satisfatórias e mostram que este procedimento tem morbidade e sobrevida aceitáveis. .