Siciliano Maria, Parlati Lucia, Maldarelli Federica, Rossi Massimo, Ginanni Corradini Stefano
Maria Siciliano, Lucia Parlati, Federica Maldarelli, Stefano Ginanni Corradini, Department of Clinical Medicine, Division of Gastroenterology, Sapienza University of Rome, 00185 Rome, Italy.
World J Gastrointest Pharmacol Ther. 2012 Aug 6;3(4):49-61. doi: 10.4292/wjgpt.v3.i4.49.
Liver transplantation is indicated in patients with acute liver failure, decompensated cirrhosis, hepatocellular carcinoma and rare liver-based genetic defects that trigger damage of other organs. Early referral to a transplant center is crucial in acute liver failure due to the high mortality with medical therapy and its unpredictable evolution. Referral to a transplant center should be considered when at least one complication of cirrhosis occurs during its natural history. However, because of the shortage of organ donors and the short-term mortality after liver transplantation on one hand and the possibility of managing the complications of cirrhosis with other treatments on the other, patients are carefully selected by the transplant center to ensure that transplantation is indicated and that there are no medical, surgical and psychological contraindications. Patients approved for transplantation are placed on the transplant waiting list and prioritized according to disease severity. Thus, the appropriate timing of transplantation depends on recipient disease severity and, although this is still a matter of debate, also on donor quality. These two variables are known to determine the "transplant benefit" (i.e., when the expected patient survival is better with, than without, transplantation) and should guide donor allocation.
肝移植适用于急性肝衰竭、失代偿期肝硬化、肝细胞癌以及引发其他器官损害的罕见肝脏遗传性缺陷患者。由于药物治疗死亡率高且病情发展不可预测，对于急性肝衰竭患者，尽早转诊至移植中心至关重要。当肝硬化在其自然病程中出现至少一种并发症时，应考虑转诊至移植中心。然而，一方面由于器官供体短缺以及肝移植后的短期死亡率，另一方面由于可用其他治疗方法处理肝硬化并发症，移植中心会对患者进行仔细筛选，以确保有肝移植指征且不存在医学、外科及心理方面的禁忌证。获批进行移植的患者会被列入移植等待名单，并根据疾病严重程度确定优先级。因此，合适的移植时机取决于受者疾病的严重程度，尽管这仍是一个有争议的问题，但也取决于供体质量。已知这两个变量决定“移植获益”（即预期患者接受移植后的生存率高于未接受移植者），并应指导供体分配。
