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目的：研究肾移植术后严重肝损害患者的临床结果。方法：分析１９９４年元月至１９９７年８月我院５１９例肾移植患者中３０例肝功严重受损患者的临床资料，ＨＣＶ－ＲＮＡ检测采用Ｎｅｓｔ－ＰＣＲ法，ＨＢｓＡｇ的测定采用ＥＬＩＳＡ法。结果：肝功严重损害患者ＨＢＶ、ＨＣＶ的感染率达９３．３％，死于肝衰竭９例，病死率为３０％，死亡患者均有ＨＢＶ或ＨＣＶ感染，且总胆红素峰值大于２００μｍｏｌ／Ｌ，存活患者急性排斥反应发生率为５７．１％，明显高于无肝功受损患者，这些患者均有停用硫唑嘌呤、环孢素Ａ或减少环孢素Ａ史。结论：ＨＢＶ、ＨＣＶ感染是肾移植术后肝功严重损害的主要原因，也是影响长期存活的重要原因之一，免疫抑制剂量不足是导致排斥反应增加的主要原因。
Objective: To study the clinical results of patients with severe liver damage after kidney transplantation. Methods: From January 1994 to August 1997 in our hospital 519 cases of renal transplant patients with severe liver function in 30 cases of clinical data, HCV-RNA detection by Nest-PCR method, HBsAg determination by ELISA method. Results: The infection rate of HBV and HCV was 93.3% in patients with severe liver damage, 9 died of liver failure and the case fatality rate was 30%. All the patients died were infected with HBV or HCV and the total bilirubin peak was more than 200μmol / L, the incidence of acute rejection in survivors was 57.1%, which was significantly higher than those without liver function impairment. All of them had withdrawal of azathioprine, cyclosporine A or reduction of cyclosporine A history. CONCLUSION: HBV and HCV infection are the main causes of severe liver damage after renal transplantation and one of the important reasons for long-term survival. Insufficient immunosuppression is the main reason leading to increased rejection.