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肝移植后皮肤问题的概述

Authors
Jean-François Dufour, MD
Patrick Antony Oberholzer, MD
Section Editor
Robert S Brown, Jr, MD, MPH
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
宋红丽, 主任医师，教授

引言

与其他实体器官移植受者相似，肝移植受者由于其长期的免疫抑制，发生皮肤问题的风险增加，但可受益于移植前和移植后的筛查；应将皮肤科医生的处理和皮肤护理纳入肝移植受者的综合性多学科治疗中[1,2]。 皮肤检查发现包括外观改变、感染、癌前病变和恶性肿瘤。皮肤改变严重程度的范围，可从良性的令人不愉快的改变至危及生命的疾病[3-5]。除皮肤癌的诊断和治疗外，至皮肤科医生处就诊还可教育患者并改善患者的防晒行为。

在所有实体器官移植中，肝移植所需免疫抑制的量最少，有时甚至可允许完全停用免疫抑制[6]。因此，与其他实体器官移植受者相比，进行肝移植的患者的皮肤并发症发生率往往更低[7]。然而，由于肝脏的体积较大，与肾、心脏或肺移植受者相比，进行肝移植的患者会接受更多的供者淋巴细胞。由于免疫抑制，移植的淋巴细胞可增殖，在罕见的情况下可引起移植物抗宿主病[8,9]。

本专题将对肝移植后可能出现的皮肤疾病进行概述。关于实体器官移植后的皮肤癌的详细讨论，以及肝移植后患者的一般处理将单独讨论。 (参见“实体器官移植后恶性肿瘤的进展”和“实体器官移植受者皮肤癌的预防和管理”和“成人肝移植受者的长期管理”)

移植对已有皮肤疾病的影响

进行肝移植的患者可能在移植前已经存在皮肤疾病，这些疾病随后受到移植的影响。在很多情况下，这些皮肤疾病可改善，这是移除病变的肝脏的结果，或是由于患者接受了免疫抑制治疗。

肝病的皮肤表现 — 对于存在与肝硬化或特定类型的肝病有关的皮肤病变的患者，移植经常可使皮肤表现改善(表 1)。

          

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Literature review current through: 2017-06 . | This topic last updated: 2015-11-16.
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