改善脂肪肝移植受者预后的研究进展

代星; 高犇; 李江

doi:10.3969/j.issn.1001-5256.2021.12.049

改善脂肪肝移植受者预后的研究进展

DOI: 10.3969/j.issn.1001-5256.2021.12.049

天津医科大学一中心临床学院，天津 300110

基金项目:

国家自然科学基金面上项目 (82072219)

详细信息

通信作者:
李江，lijiang_009@163.com

中图分类号: R575.5; R617
计量
- 文章访问数: 380
- HTML全文浏览量: 95
- PDF下载量: 43
- 被引次数: 0
出版历程
- 收稿日期: 2021-05-08
- 录用日期: 2021-05-31
- 出版日期: 2021-12-20

Research advances in improving the prognosis of recipients of fatty liver transplantation

The First Central Clinical College of Tianjin Medical University, Tianjin 300110, China

Research funding:

National Natural Science Foundation of China(General Program) (82072219)

摘要

摘要: 随着器官移植供体需求量不断增加，边缘供体运用越来越多。脂肪供肝的应用成为肝移植科医生需要面对的新问题，相对于正常供肝，脂肪肝术后并发症的发生率更高，临床的治疗难度更大。介绍了改善脂肪肝移植受者预后的措施，指出通过这些措施可以降低脂肪肝移植的风险，从而提高脂肪肝供体的利用率。
- 脂肪肝 /
- 肝移植 /
- 移植受体 /
- 预后
Abstract: With the increasing demand for liver donors, more and more marginal donors have been used. How to use fatty liver grafts has become a new issue that physicians in the department of liver transplantation must face. Compared with the normal donor liver, fatty liver grafts have high incidence of postoperative complications and increase the difficulty of clinical cure. This review describes the measures to improve the prognosis of recipients of fatty liver transplantation, and points out that these measures can reduce the risk of fatty liver transplantation and thus increase the utilization of fatty liver grafts.
- Fatty Liver /
- Liver Transplantation /
- Transplant Recipients /
- Prognosis

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表 1 脂肪肝供受体匹配准则

第一作者	年份	例数	供肝来源	供肝病理	匹配准则	预后
Dutkowski P^[14]	2012	530	死亡供体	中重度大泡性脂肪肝	以受体年龄、MELD评分、首次移植、冷缺血时间、供体年龄为新的风险平衡评分指标，使新风险平衡评分＜9	PNF发生率增加，但是受者1年内生存率高(82%)
Chavin KD^[15]	2013	27	死亡供体	中重度脂肪肝	供体标准：年龄＜60岁、未使用收缩血管的药物、ICU的时间＜48 h、血清转氨酶水平正常、钠离子＜155 mmol/L、无急性心肌梗塞、无糖尿病、BMI＜40 kg/m²，满足以上7项则可进行移植。否则需要受体达成以下标准：年龄＜60岁、无暴发性肝衰竭、首次移植、无门静脉血栓、无多次腹腔手术史、无自发性细菌性腹膜炎、MELD评分＜30、BMI＜40 kg/m²	中度脂肪肝：术后胆道并发症概率增加(35%)，5年内患者生存率(63%)和移植物生存率(70%)高于轻度脂肪肝重度脂肪肝：5年内患者生存率和移植物生存率均为73%
Westerkamp AC^[16]	2015	19	DCD，DBD	中度大泡性脂肪肝	供肝冷缺血时间＜8 h	术后并发症发生率低于正常肝脏，患者及移植物生存率与正常肝脏没有差异
Wong TC^[17]	2016	19	DCD	重度大泡性脂肪肝	供肝冷缺血时间＜7 h、受者低MELD评分	患者及移植物生存率与轻中度脂肪肝相同，未发生PNF
Nacif LS^[18]	2018	65	死亡供体	中度脂肪肝	受者标准：＜65岁、首次移植、无暴发性肝炎、无门静脉血栓、无腹部多次手术史、无严重心脏疾病、MELD评分＜29、无上消化道出血、无自发性腹膜炎，无胆管炎、无3级以上肝性脑病、无感染、无肾功能不全	患者1年内生存率89%，移植物1年内生存率86%
Mangus RS^[19]	2020	151	DCD	中度大泡及小泡性脂肪肝	受者年龄＜40岁、供体在ICU时长＞5 d	术后脂肪肝比例会迅速减少，未提及预后
Jackson KR^[9]	2020	2048	死亡供体	轻中度大泡性脂肪肝	受者标准：首次移植、MELD评分15~34、无原发性胆汁硬化，术前未使用生命支持系统	患者病死率和PNF发生率低于未进行匹配的正常供肝
注：DCD，心脏死亡器官捐献；DBD，脑死亡器官捐献。

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参考文献(34)

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