目的:探讨肝肾联合移植受者治疗和管理经验。方法:回顾性分析解放军总医院第八医学中心2003年11月至2019年6月22例肝肾联合移植受者手术、免疫抑制剂应用以及远期随访数据。结果:22例肝肾联合移植受者术后3个月内死亡5例，1、3、5、10年存活率分别为77.3%、72.4%、66.9%、66.9%。围手术期死亡与移植肾延迟恢复、肺部感染呈正相关(n P＝0.000和n P＝0.039)，与原发病、术前是否透析治疗、手术时间和术中出血量等无明显相关。顺利度过围手术期受者免疫抑制剂应用参照单纯肝脏移植受者，用量低于单纯肾脏移植受者，排斥反应发生率无明显升高。移植肾功能延迟恢复与供肾冷缺血时间及远期移植肾功能不全无明显相关(n P＝0.053和n P＝0.074)。术后1个月停用激素受者与术后3个月停用激素受者比较，急性排斥反应的发生率无明显增加。2例受者远期发生泌尿系移行细胞癌，手术切除并加用西罗莫司治疗后预后良好。n 结论:肝肾联合移植围手术期死亡与移植肾功能延迟恢复、肺部感染明显相关，其免疫抑制剂应用可以参考单肝移植，如顺利度过围手术期，可以得到良好的远期预后。“,”Objective:To explore the management experience of patients undergoing liver and kidney co-transplantation.Methods:From November 2003 to June 2019, retrospective analysis was performed for perioperative management, immunosuppressive therapy and prognosis of 22 patients after liver and kidney co-transplantation.Results:Five of them died within 3 months after co-transplantation. The 1/3/5/10-yearsurvival rates were 77.3%, 72.4%, 66.9% and 66.9% respectively. Perioperative mortality was positively correlated with delayed graft function and pulmonary infection (n P=0.000 & n P=0.039). No significant correlation existed between perioperative mortality, primary disease, preoperative dialysis, operative duration or intraoperative blood loss. The dose of immunosuppressive agents in patients of liver and kidney co-transplantation was similar to those of single liver transplantation. It was significantly lower than in those of single kidney transplantation. However, the incidence of allograft rejection was not significantly elevated. Delayed graft function of donor kidney was not significantly correlated with cold ischemic time of donor kidney or long-term renal insufficiency (n P=0.053 & n P=0.074). No significant difference existed in the incidence of acute rejection between patients withdrawing steroid at the end of Month 1 and those withdrawing steroid at the end of Month 3 post-operation. Two patients developed ureteral neoplasm during follow-ups. Prognosis was excellent after surgical resection and treatment with sirolimus.n Conclusions:Delayed graft function and pulmonary infection are both significantly correlated with perioperative mortality. Immunosuppressive scheme of single liver transplantation may be utilized as a reference for liver and kidney co-transplantation. Liver and kidney co-transplant patients have decent long-term prognoses if surviving smoothly through perioperative period.