肝移植术后中远期并发症的防治任务与策略

刘懿禾; 郑虹; 沈中阳

doi:10.3969/j.issn.1001-5256.2019.11.002

肝移植术后中远期并发症的防治任务与策略

DOI: 10.3969/j.issn.1001-5256.2019.11.002

天津市第一中心医院器官移植中心中国医学科学院移植医学重点实验室国家卫生健康委员会危重病急救医学重点实验室天津市器官移植重点实验室

基金项目:

天津市器官移植临床医学研究中心项目(15ZXLCSY00070)；中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2019PT320016)；

详细信息

中图分类号: R657.3
计量
- 文章访问数: 1339
- HTML全文浏览量: 43
- PDF下载量: 378
- 被引次数: 0
出版历程
- 收稿日期: 2019-10-08
- 出版日期: 2019-11-20

Tasks and strategies for the prevention and treatment of middle-and long-term complications after liver transplantation

Center of Organ Transplantation,Tianjin First Center Hospital,Key Laboratory of Transplant Medicine,Chinese Academy of Medical Sciences,Key Laboratory of National Health Commission for Critical Care and Emergency Medicine,Tianjin Key Laboratory for Organ Transplantation

Research funding:

摘要

摘要: 随着肝移植技术的持续改进及关联学科领域创新成果的涌现与借鉴,肝移植术后中远期并发症在病因构成与临床转归等方面正在悄然迁变,其防治对策值得探究与调整。近年,防治肝炎复发等移植后并发症取得了突破性进展,但应加强规范化诊疗,以使移植受者最大程度获益。迄今,防治发病机制不明及成因复杂的肝移植术后中远期并发症,仍主要依赖于针对相关风险因素的长期监测与防控。维护移植肝功能、控制原发病复发、防治新发疾病及接续治疗术前并存疾病,是实施肝移植受者长期管理的主要任务方向。以此为线索,概括阐述了当前肝移植术后中远期并发症的防治任务与策略。
- 肝移植 /
- 手术后并发症 /
- 治疗学
Abstract: With the continuous improvement of liver transplantation techniques and the innovation of related disciplines,great changes have been observed in the etiology and clinical outcome of middle-and long-term complications after liver transplantation,and thus related prevention and treatment strategies are worthy of exploration and adjustment. In recent years,breakthroughs have been made in the prevention and treatment of post-transplantation complications including the recurrence of hepatitis,but standardized diagnosis and treatment should be strengthened in order to maximize the benefits of recipients. So far,the prevention and treatment of middle-and long-term complications with unknown pathogenesis and complicated causes after liver transplantation still rely on the long-term monitoring,prevention,and control of related risk factors. The main tasks of long-term management of liver transplantation recipients is to maintain the function of transplanted liver,control the recurrence of primary diseases,prevent and treat the new-onset diseases,and continue to treat the concomitant diseases before surgery. This article elaborates on the tasks and strategies for the prevention and treatment of middle-and long-term complications after liver transplantation.
- liver transplantation /
- postoperative complications /
- therapeutics

HTML全文

参考文献(29)

[1] CHEN ZH. Problems and significance of liver allograft as an immunologically privileged organ[J]. Chin J Hepatol,2005,13(3):221.(in Chinese)陈忠华．同种肝脏移植免疫特惠器官现象及其临床意义[J]．中华肝脏病杂志，2005,13(3):221.

[2] FISHMAN JA. Infection in solid-organ transplant recipients[J]. N Engl J Med,2007,357(25):2601-2614.

[3] KANEKU H,O'LEARY JG,TANIGUCHI M,et al. Donor-specific human leukocyte antigen antibodies of the immunoglobulin G3 subclass are associated with chronic rejection and graft loss after liver transplantation[J]. Liver Transpl,2012,18(8):984-992.

[4] ZHANG HM,LI SR,YU Y,et al. Bi-directional roles of IRF-1 on autophagy diminish its prognostic value as compared with Ki67 in liver transplantation for hepatocellular carcinoma[J].Oncotarget,2016,7(25):37979-37992.

[5] WANG Z,GONG W,SHOU D,et al. Clonal origin of hepatocellular carcinoma and recurrence after liver transplantation[J]. Ann Transplant,2016,21:484-490.

[6] WU D,ZHENG H,SHEN ZY,et al. Clinical significance of detection of the disseminating tumor cell before and during liver transplantation of HCC[J]. Chin J Organ Transplant,2007,28(4):217-219.(in Chinese)吴迪，郑虹，沈中阳，等．检测肝癌肝移植患者术前和术中肿瘤播散状况的临床意义[J]．中华器官移植杂志，2007,28(4):217-219.

[7] LI JJ,JIANG WT,ZHENG H,et al. Tumor free technique in liver transplantation for liver cancer[J/CD]. Prac J Organ Transplant:Electronic Version,2017,5(4):266-267.(in Chinese)李俊杰，蒋文涛，郑虹，等．肝癌肝移植术中无瘤技术[J]．实用器官移植电子杂志，2017,5(4):266-267.

[8] DELEON TT,SALOMAO MA,AQEL BA,et al. Pilot evaluation of PD-1 inhibition in metastatic cancer patients with a history of liver transplantation:The Mayo Clinic experience[J]. J Gastrointest Oncol,2018,9(6):1054-1062.

[9] JENSSEN T,HARTMANN A. Post-transplant diabetes mellitus in patients with solid organ transplants[J]. Nat Rev Endocrinol,2019,15(3):172-188.

[10] WANG H,JIANG W,ZHOU Z,et al. Liver transplantation in mainland china:The overview of CLTR 2011 annual scientific report[J]. Hepatobiliary surg Nutr,2013,2(4):188-197

[11] American Diabetes Association. Classification and diagnosis of diabetes:Standards of medical care in diabetes-2018[J]. Diabetes Care,2018,41(Suppl1):s13-s27.

[12] VAJDIC CM,van LEEUWEN MT. Cancer incidence and risk factors after solid organ transplantation[J]. Int J Cancer,2009,125(8):1747-1754.

[13] de MARTEL C,FERLAY J,FRANCESCHI S,et al. Gobal burden of cancers attributable to infections in 2008:A review and synthetic analysis[J]. Lancet Oncol,2012,13(6):607-615.

[14] ABERG F,PUKKALA E,HOCKERSTEDT K,et al. Risk of malignant neoplasms after liver transplantation:A populationbased study[J]. Liver Transpl,2008,14(10):1428-1436.

[15] van LEEUWEN MT,WEBSTER AC,MCCREDIE MR,et al.Effect of reduced immunosuppression after kidney transplant failure on risk of cancer:Population based retrospective cohort study[J]. BMJ,2010,340:c570.

[16] ZELLE DM,CORPELEIJN E,DEINUM J,et al. Parcreaticβ-cell dysfunction and risk of new-onset diabetes after kidney transplantation[J]. Diabetes Care,2013,36(7):1926-1932.

[17] MARTINEZ OM,KRAMS SM. The immune response to Epstein Barr Virus and implications for posttransplant lymphoproliferative disorder[J]. Transplantation,2017,101(9):2009-2016.

[18] KOTTON CN,HUPRIKAR S,KUMAR D. Transplant infectious diseases:A review of the scientific registry of transplant recipients published data[J]. Am J Transplant,2017,17(6):1439-1446.

[19] SWERDLOW SH,CAMPO E,PILERI SA,et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms[J]. Blood,2016,127(20):2375-2390.

[20] OSTENSEN AB,SANENGEN T,HOLTER E,et al. No effect of treatment with intravenous ganciclovir on Epstein-Barr virus viremia demonstrated after pediatric liver transplantation[J].Pediatr Transplant,2017,21(6):e13010.

[21] TRAPPE RU,DIERICKX D,ZIMMERMANN H,et al. Response to rituximab induction is a predictive marker in B-cell posttransplant lymphoproliferative disorder and allows successful stratification into rituximab or R-CHOP consolidation in an international,prospective,multicenter phase II trial[J]. J Clin Oncol,2017,35(5):536-543.

[22] HERRERO JI,PARDO F,D’AVOLA D,et al. Risk factors of lung,head and neck,esophageal,and kidney and urinary tract carcinomas after liver transplantation:The effect of smoking withdrawal[J]. Liver Transpl,2011,17(4):402-408.

[23] BACCARANI U,PISELLI P,SERRAINO D,et al. Comparison of de novo tumours after liver transplantation with incidence rates from Italian cancer registries[J]. Dig Liver Dis,2010,42:55-60.

[24] DENNY LA,FRANCESCHI S,de SANJOSES,et al. Human papillomavirus,human immunode ciency virus and immunosuppression[J]. Vaccine,2012,30(Suppl 5):f168-f174.

[25] MAGGI U,CONSONNI D,MANINI MA,et al. Early and late de novo tumors after liver transplantation in adults:The late onset of bladder tumors in men[J]. PLo S One,2013,8:e65238.

[26] LOWRANCE WT,ORDONEZ J,UDALTSOVA N,et al. CKD and the risk of incident cancer[J]. J Am Soc Nephrol,2014,25(10):2327-2334.

[27] MARTIN SI,DODSON B,WHEELER C,et al. Monitoring infection with Epstein-Barr virus among seromismatch adult renal transplant recipients[J]. Am J Transplant,2011,11(5):1058-1063.

[28] DANTAL J,CAMPONE M. Daunting but worthy goal:Reducing the de novo cancer incidence after transplantation[J].Transplantation,2016,100(12):2569-2583.

[29] FRANCOZ C,DURAND F,KAHN JA,et al. Hepatorenal syndrom[J]. Clin J Am Soc Nephrol,2019,14(5):774-781.

施引文献

资源附件(0)

访问统计