慢加急性肝衰竭肝移植评估决策的演进、融合与挑战

武羽; 徐曼曼; 陈煜

doi:10.12449/JCH260307

慢加急性肝衰竭肝移植评估决策的演进、融合与挑战

DOI: 10.12449/JCH260307

首都医科大学附属北京佑安医院肝病中心四科，北京 100069

基金项目:

首都卫生发展科研专项 (2024-1-2181);

北京市医院管理中心“登峰”计划专项 (DFL20221501);

新发突发与重大传染病防控国家科技重大专项 (2025ZD01906501)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：武羽负责文献检索，初稿撰写及修改；徐曼曼负责论文修改；陈煜负责拟定写作思路，指导论文撰写并修改论文。

详细信息

通信作者:
陈煜， chybeyond1071@ccmu.edu.cn （ORCID： 0000-0003-1906-7486）

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出版历程
- 收稿日期: 2025-12-16
- 录用日期: 2026-01-22
- 出版日期: 2026-03-25

Evaluation and decision-making for liver transplantation in acute-on-chronic liver failure： Evolution， integration， and challenges

Fourth Department of Liver Disease Center，Beijing YouAn Hospital，Capital Medical University，Beijing 100069，China

Research funding:

Capital’s Funds for the Health Improvement and Research (2024-1-2181);

Beijing Hospitals Authority’s Ascent Plan (DFL20221501);

Prevention and Control of Emerging and Major Infectious Diseases-National Science and Technology Major Project (2025ZD01906501)

More Information

Corresponding author: CHEN Yu， chybeyond1071@ccmu.edu.cn （ORCID： 0000-0003-1906-7486）

摘要

摘要: 慢加急性肝衰竭是在慢性肝病基础上出现的急性肝功能失代偿综合征，短期病死率高，肝移植是确切有效的根治性手段，可显著提高生存率。然而，在全球性器官短缺的背景下，如何在拯救生命与避免无效移植并优化器官利用之间取得平衡，是临床决策的关键。本文系统梳理了慢加急性肝衰竭患者肝移植评估决策体系的演进，指出其核心已从依赖单一的终末期肝病模型评分，转变为基于多维度预后模型、动态评估和多学科协作的模式。未来，融合东西方标准、利用人工智能精准预测以及建立更公平的优先分配系统，将是该领域发展的关键方向。
- 慢加急性肝功能衰竭 /
- 肝移植 /
- 危险性评估
Abstract: Acute-on-chronic liver failure （ACLF） is a syndrome of acute liver function decompensation in patients with chronic liver disease and is characterized by a high short-term mortality rate. Liver transplantation is an effective radical treatment method for ACLF and can significantly improve the survival rate of patients. However， in the context of a shortage of donor organs globally， how to achieve a balance between saving lives and avoiding futile transplantation while optimizing organ utilization is a critical challenge in clinical decision-making. This article systematically reviews the evolution of the evaluation and decision-making system for liver transplantation in ACLF patients and points out s that the core of this system has shifted from relying solely on the MELD score to a model based on multidimensional prognostic assessment， dynamic evaluation， and multidisciplinary collaboration. In the future， the integration of Eastern and Western criteria， the application of artificial intelligence for precise prediction， and the establishment of a more equitable priority and allocation system will be the key directions for development in this field.
- Acute-On-Chronic Liver Failure /
- Liver Transplantation /
- Risk Assessment

HTML全文

注： ACLF，慢加急性肝衰竭；MELD-Na，终末期肝病模型联合血清钠；COSSH-ACLF Ⅱ，中国重型乙型肝炎研究小组慢加急性肝衰竭2.0版；CLIF-C ACLF，慢性肝衰竭联盟-慢加急性肝衰竭；TAM，ACLF 3级患者肝移植模型；HALT，乙型肝炎病毒相关慢加急性肝衰竭肝移植模型；SALT-M，Sundaram ACLF肝移植死亡率。

图 1 ACLF患者肝移植决策体系图

Figure 1. Liver transplant decision-making system for ACLF patients

下载: 全尺寸图片幻灯片

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