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小儿肝移植:选择标准和移植后医疗管理。

Pediatric Liver Transplantation: Selection Criteria and Post-transplant Medical Management.

机构信息

Pediatric Liver GI and Nutrition Centre and Mowat Labs, King's College Hospital, London, SE5 9RS, UK.

出版信息

Indian J Pediatr. 2024 Apr;91(4):383-390. doi: 10.1007/s12098-023-04963-5. Epub 2023 Dec 27.

Abstract

Pediatric liver transplantation remains the gold standard for life-threatening acute and chronic liver diseases and multiple liver-based inherited metabolic defects. Advances in surgical techniques, better perioperative care and immunosuppression regimes have resulted in excellent long-term graft and patient survival. The success of pediatric liver transplantation does however bring the additional challenge of long-term patient outcomes including graft hepatitis-related fibrosis and suboptimal biopsychosocial outcomes. In this review, authors will explore the current landscape of pediatric liver transplantation including indications, timing of referral for liver transplantation, surgical techniques and long-term outcomes such as recurrence of pre-transplant liver disease, idiopathic graft hepatitis and biopsychosocial outcomes. Ultimately, early identification and management of potential issues long-term helps ensure our recipients achieve a "meaningful survival".

摘要

小儿肝移植仍然是危及生命的急性和慢性肝病以及多种基于肝脏的遗传性代谢缺陷的金标准。手术技术的进步、更好的围手术期护理和免疫抑制方案,使肝移植的长期移植物和患者存活率达到了非常高的水平。然而,小儿肝移植的成功带来了长期患者预后的额外挑战,包括移植物肝炎相关纤维化和不理想的生物心理社会结局。在这篇综述中,作者将探讨小儿肝移植的现状,包括适应证、肝移植的转诊时机、手术技术和长期结果,如移植前肝病的复发、特发性移植物肝炎和生物心理社会结局。最终,早期识别和管理潜在问题有助于确保我们的受者实现“有意义的生存”。

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