Rubín Angel, Berenguer Marina
Unidad de Hepatología y Trasplante Hepático, Hospital La Fe, Valencia, España.
Gastroenterol Hepatol. 2013 Jan;36(1):48-57. doi: 10.1016/j.gastrohep.2012.03.006. Epub 2012 May 9.
Transplantation has become the treatment of choice in end-stage liver disease, with 5-year survival rates of around 68-74% in European and North-American registries (www.unos.org, www.eltr.org, www.ont.es). These results are largely due to the development of powerful immunosuppressive agents, mainly calcineurin inhibitors. However, these immunosuppressive drugs are not free of adverse effects, especially nephrotoxicity. Moreover, two of the most frequent indications for transplantation, cirrhosis due to hepatitis C virus and hepatocellular carcinoma, can recur in the transplanted graft. Whether specific immunosuppression could be less harmful in these conditions is the subject of debate. With the greater use of suboptimal donors and of expanded criteria for liver transplantation in patients with hepatocellular carcinoma, aggressive recurrences can be expected to increase. The present review attempts to elucidate whether there is an immunosuppression strategy that could minimize the risk of aggressive tumoral recurrence or recurrence of hepatitis C.
移植已成为终末期肝病的首选治疗方法，在欧洲和北美的登记处，5年生存率约为68%-74%（www.unos.org、www.eltr.org、www.ont.es）。这些结果很大程度上归功于强效免疫抑制剂的发展，主要是钙调神经磷酸酶抑制剂。然而，这些免疫抑制药物并非没有不良反应，尤其是肾毒性。此外，移植的两个最常见适应症，丙型肝炎病毒所致肝硬化和肝细胞癌，可在移植肝中复发。在这些情况下，特异性免疫抑制是否危害较小是一个有争议的问题。随着次优供体的更多使用以及肝细胞癌患者肝移植扩大标准的应用，侵袭性复发预计会增加。本综述试图阐明是否存在一种免疫抑制策略，可以将侵袭性肿瘤复发或丙型肝炎复发的风险降至最低。
