Lai Jennifer C
University of California, San Francisco, California, USA.
Curr Opin Organ Transplant. 2016 Apr;21(2):127-32. doi: 10.1097/MOT.0000000000000286.
The most difficult, and perhaps, most important decision that a clinician makes for a patient on the liver transplant wait-list is when 'not' to proceed with liver transplant. Although an individual may be suitable for transplant surgery at listing, he/she may become too sick while waiting.
This article reviews four specific conditions that commonly arise on the wait-list that may render a candidate too sick for transplant: advancing age, sarcopenia, acute on chronic liver failure, and nonliver-related medical comorbidities. Each condition, per se, is often not a criterion for delisting; the challenge arises when conditions exist in combination--how does one 'sum' up these conditions to quantify risk? Physical frailty, conceptually, represents the conditions in a candidate that are unlikely to reverse after liver function returns, or will take so long to reverse that the patient will be highly vulnerable to postoperative complications. Pretransplant assessments of physical frailty, which are objective, easily administered, and repeated in the clinical setting, enable us to measure the extent to which these factors, in isolation or combination, will reduce both quantity and quality of life after liver transplant.
In this article, I introduce a framework that incorporates objective pretransplant assessments of physical frailty to facilitate the decision regarding when a patient is too sick for transplant.
临床医生为肝移植等待名单上的患者做出的最困难、或许也是最重要的决定是何时“不”进行肝移植。尽管个体在列入名单时可能适合移植手术，但在等待过程中可能会病情加重。
本文回顾了等待名单上常见的四种特定情况，这些情况可能使候选者病情过重而无法进行移植：高龄、肌肉减少症、慢性肝衰竭急性发作以及非肝脏相关的内科合并症。每种情况本身往往并非退出名单的标准；当多种情况同时存在时挑战就出现了——如何“综合”这些情况来量化风险？从概念上讲，身体虚弱代表候选者中那些在肝功能恢复后不太可能逆转，或者需要很长时间才能逆转，以至于患者极易发生术后并发症的情况。在临床环境中，对身体虚弱进行客观、易于实施且可重复的移植前评估，能让我们衡量这些因素单独或综合起来会在多大程度上降低肝移植后的生活质量和寿命。
在本文中，我介绍了一个框架，该框架纳入了对身体虚弱的客观移植前评估，以促进关于患者何时病情过重而无法进行移植的决策。
