肝肾联合移植临床诊疗指南

中华医学会器官移植学分会; 孙煦勇; 蓝柳根; 文宁; 董建辉; 吴基华

doi:10.3969/j.issn.1674-7445.2024129

肝肾联合移植临床诊疗指南

doi: 10.3969/j.issn.1674-7445.2024129

530007　南宁，广西医科大学第二附属医院

基金项目: 广西重点研发计划（桂科AB24010059）

详细信息

通讯作者:
孙煦勇，医学博士，主任医师，研究方向为移植医学，Email：sxywn@sohu.com

中图分类号: R617, R692, R575
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- 文章访问数: 99
- HTML全文浏览量: 35
- PDF下载量: 27
- 被引次数: 0
出版历程
- 收稿日期: 2024-04-28
- 网络出版日期: 2024-05-30
- 刊出日期: 2024-07-15

Guidelines for clinical diagnosis and treatment of combined liver and kidney transplantation

Branch of Organ Transplantation of Chinese Medical Association,

The Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, China

More Information

Corresponding author: Sun Xuyong, Email: sxywn@sohu.com

摘要

摘要: 肝肾联合移植相继应用于各大移植中心，使许多终末期肝、肾衰竭患者重获新生。然而肝肾联合移植术的临床诊疗及长期生存预后仍存在较多需要解决的问题。本指南参考《肝肾联合移植技术操作规范（2019版）》和国内外已发表的最新文献和指南，制定了《肝肾联合移植临床诊疗指南》。就肝肾联合移植的手术指征和禁忌证、术前准备和评估、在终末期肝病和肾病中移植的时机、手术方法的选择以及术后随访、联合移植受者的独特病理生理学、外科技术、并发症管理和免疫抑制治疗的选择等临床问题提出推荐意见，以提高移植物利用率，改善肝肾联合移植受者的生存预后。
- 肝肾联合移植 /
- 肝移植 /
- 肾移植 /
- 排斥反应 /
- 免疫抑制药 /
- 术前评估 /
- 术后并发症 /
- 围手术期管理
Abstract: Combined liver and kidney transplantation has been steadily applied in major transplantation centers, saving the lives of many patients with end-stage liver and renal failure. However, there are still multiple unresolved problems in the clinical diagnosis, treatment and long-term prognosis of combined liver and kidney transplantation. By referring to "Technical Operating Standards for Combined Liver and Kidney Transplantation (2019 Edition)" and the latest published literature and guidelines at home and abroad, "Guidelines for Clinical Diagnosis and Treatment of Combined Liver and Kidney Transplantation" was formulated. Recommendations and suggestions were delivered regarding the surgical indications and contraindications, preoperative preparation and evaluation, the timing of transplantation for end-stage liver and kidney diseases, the selection of surgical approaches and postoperative follow-up, specific pathophysiology, surgical techniques, complication management and immunosuppressive treatment of combined live and kidney transplantation, aiming to enhance the utilization rate of grafts and improve the survival and prognosis of combined liver and kidney transplant recipients.
- Combined liver and kidney transplantation /
- Liver transplantation /
- Kidney transplantation /
- Rejection /
- Immunosuppressant /
- Preoperative evaluation /
- Postoperative complication /
- Perioperative management

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FIG. 3249. FIG. 3249.

FIG. 3249.. FIG. 3249.

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表 1 证据质量与推荐强度分级

Table 1. Evidence quality and recommended strength grades

推荐强度	证据级别	描述
A	1a	随机对照试验的系统评价
	1b	结果可信区间小的随机对照试验
	1c	显示“全或无效应”的任何证据
B	2a	队列研究的系统评价
	2b	单个队列研究（包括低质量的随机对照试验，如失访率>20%）
	2c	基于患者结局的研究
	3a	病例对照研究的系统评价
	3b	单个病例对照研究
C	4	病例系列报告、低质量队列研究和低质量病例对照研究
D	5	专家意见（即无临床研究支持的仅依据基础研究或临床经验的推测）

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表 2 AKI的定义和分类

Table 2. Definition and classification of AKI

AKI分级	血清肌酐标准	尿量标准
1（危险）	48 h内增加≥18 μmol/L或较基线升高1.5～2.0倍	<0.5 mL/（kg·h）持续时间>6h
2（损伤）	较基线升高1.5～2.0倍	<0.5 mL/（kg·h）持续时间>12 h
3（衰竭）	较基线升高1.5～2.0倍或≥240 μmol/L伴Scr急性升高≥30 μmol/L，或开始肾脏替代治疗	<0.3 mL/（kg·h）持续24 h，或无尿12 h

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