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肝移植适应证的演变:拓展视野。

Evolution of Liver Transplantation Indications: Expanding Horizons.

机构信息

Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy.

出版信息

Medicina (Kaunas). 2024 Feb 28;60(3):412. doi: 10.3390/medicina60030412.

Abstract

Liver transplantation (LT) has significantly transformed the prognosis of patients with end-stage liver disease and hepatocellular carcinoma (HCC). The traditional epidemiology of liver diseases has undergone a remarkable shift in indications for LT, marked by a decline in viral hepatitis and an increase in metabolic dysfunction-associated steatotic liver disease (MASLD), along with expanded indications for HCC. Recent advancements in surgical techniques, organ preservation and post-transplant patients' management have opened new possibilities for LT. Conditions that were historically considered absolute contraindications have emerged as potential new indications, demonstrating promising results in terms of patient survival. While these expanding indications provide newfound hope, the ethical dilemma of organ scarcity persists. Addressing this requires careful consideration and international collaboration to ensure equitable access to LT. Multidisciplinary approaches and ongoing research efforts are crucial to navigate the evolving landscape of LT. This review aims to offer a current overview of the primary emerging indications for LT, focusing on acute-on-chronic liver failure (ACLF), acute alcoholic hepatitis (AH), intrahepatic and perihilar cholangiocarcinoma (i- and p-CCA), colorectal liver metastasis (CRLM), and neuroendocrine tumor (NET) liver metastases.

摘要

肝移植(LT)显著改善了终末期肝病和肝细胞癌(HCC)患者的预后。肝脏疾病的传统流行病学在 LT 的适应证方面发生了显著变化,病毒性肝炎的发病率下降,代谢功能障碍相关脂肪性肝病(MASLD)的发病率上升,同时 HCC 的适应证也扩大了。手术技术、器官保存和移植后患者管理方面的最新进展为 LT 开辟了新的可能性。历史上被认为是绝对禁忌证的情况现在已经成为潜在的新适应证,在患者生存率方面取得了有前景的结果。虽然这些扩展的适应证带来了新的希望,但器官短缺的伦理困境仍然存在。解决这个问题需要仔细考虑和国际合作,以确保 LT 的公平可及性。多学科方法和持续的研究努力对于驾驭 LT 的不断发展的领域至关重要。本综述旨在提供 LT 的主要新兴适应证的最新概述,重点介绍慢性肝衰竭急性发作(ACLF)、急性酒精性肝炎(AH)、肝内和肝门部胆管癌(i- 和 p-CCA)、结直肠癌肝转移(CRLM)和神经内分泌肿瘤(NET)肝转移。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b4bf/10972065/7aa5fc1f7e11/medicina-60-00412-g001.jpg

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