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成人肝移植：患者选择和术前评估

Authors
Lorna M Dove, MD, MPH
Robert S Brown, Jr, MD, MPH
Section Editor
Keith D Lindor, MD
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
柳青峰, 主任医师

引言

肝移植是急性肝衰竭、终末期肝病和原发性肝癌患者的一种重要治疗方法，但其并不能作为大多数肝病的初始或一线治疗方法。

移植常常不能治愈基础疾病；患者肝移植后肝病的复发率为0-100%不等，取决于肝移植所针对的具体原发疾病。因此，移植人选的选定是一种风险效益分析，在此过程中，必须权衡移植的固有风险(包括手术、疾病复发和长期免疫抑制)与移植的可能获益。移植获益因人而异，但都包括改善生存情况、预防长期并发症，以及获得更好的健康相关生活质量。在大多数情况下，疾病复发相关的风险不会超过肝移植的获益。

本专题将总结肝移植的患者选择和术前评估。与肝移植相关的其他问题将在别处讨论，包括供者选择、活体供肝肝移植、肝移植中的伦理问题、肝移植后的免疫抑制及肝移植患者的内科治疗。 (参见“肝脏移植的供者选择”和“活体肝移植”和“肝脏移植中的伦理问题”和“成人肝脏移植的免疫抑制概述”和“成人肝移植受者的长期管理”)

2013年美国肝病研究协会和美国移植协会发布了有关肝移植适应证和评估考虑肝移植患者的指南(guidelines)[1]。以下的讨论与那些指南基本一致。

适应证

肝移植的适应证包括急性肝衰竭、伴并发症的肝硬化、某些肝脏肿瘤，以及以肝脏为基础伴全身性表现的代谢性疾病[1,2]。

                      

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-29.
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