Said Adnan, Einstein Michael, Lucey Michael R
Section of Gastroenterology and Hepatology, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI 53792, USA.
Curr Opin Gastroenterol. 2007 May;23(3):292-8. doi: 10.1097/MOG.0b013e3280f9df41.
Recent attention in liver transplantation has focused on equity in organ allocation and management of posttransplant complications.
Adoption of the model for end-stage liver disease for liver allocation has been successful in implementing a system based on medical urgency rather than waiting time. Refinements are being studied in improving the prediction of mortality and improving transplant benefit by balancing pretransplant mortality and posttransplant survival. Emerging literature is examining expansion of the current criteria for transplantation of hepatocellular carcinoma and the role of neoadjuvant therapy. Chronic renal dysfunction after liver transplantation is a source of considerable morbidity. Nephron-sparing immunosuppression regimens are emerging with encouraging results. Hepatitis C virus infection is difficult to differentiate histologically from rejection, although newer markers are being developed. Antiviral and immunosuppressive strategies for reducing the severity of hepatitis C virus recurrence are discussed. Alcohol relapse is common after liver transplant in alcoholic liver disease patients and can lead to worse outcomes.
Organ allocation tends to evolve under the model for end-stage liver disease with a focus on maximizing transplant benefit. Hepatitis C virus, hepatocellular carcinoma, chronic renal dysfunction and alcohol relapse are major challenges, and continued research in these areas will undoubtedly lead to better outcomes for transplant recipients.
近期肝移植领域的关注焦点在于器官分配的公平性以及移植后并发症的管理。
采用终末期肝病模型进行肝脏分配已成功建立起一个基于医疗紧迫性而非等待时间的系统。目前正在研究改进措施，以通过平衡移植前死亡率和移植后生存率来提高死亡率预测和移植获益。新出现的文献正在探讨扩大肝细胞癌当前移植标准以及新辅助治疗的作用。肝移植后的慢性肾功能障碍是相当大一部分发病的根源。保留肾单位的免疫抑制方案正在兴起，结果令人鼓舞。丙型肝炎病毒感染在组织学上难以与排斥反应区分开来，不过正在研发新的标志物。文中讨论了降低丙型肝炎病毒复发严重程度的抗病毒和免疫抑制策略。酒精性肝病患者肝移植后酒精复饮很常见，且可能导致更差的结局。
在终末期肝病模型下，器官分配往往会不断演变，重点是使移植获益最大化。丙型肝炎病毒、肝细胞癌、慢性肾功能障碍和酒精复饮是主要挑战，这些领域的持续研究无疑将为移植受者带来更好的结局。
