我国心脏死亡器官捐献供肝现状及其肝移植的临床进展

肝移植是治疗终末期肝病的重要手段,但是供体短缺的问题日益显现,因此适合我国国情,同时符合国际标准的心脏死亡器官捐献(DCD)应该是现阶段缓解器官短缺的一种重要手段。本文回顾了国际上DCD肝移植的曲折发展历程,通过对DCD肝移植的定义与分类、伦理原则、适应证、获取方案、捐献情况和临床效果进行综述,认为DCD供肝是目前我国肝移植供体极度短缺大环境下的一支"生力军"。随着其工作的深入开展,必将成为我国肝移植的重要组成部分。     

肝癌肝移植的研究进展与挑战

［摘要］　　肝移植是根治终末期肝病的有效手段之一,为肝癌患者提供了新的选择。然而,术后肿瘤复发、转移已成为影响肝移植疗效的最主要因素,是肝癌肝移植必须面临的挑战。该文就肝癌肝移植的适应证标准、候肝期治疗、免疫治疗、肿瘤监测、复发治疗进行述评,为肝癌肝移植的临床应用提供临床参考。     

吉林大学第一医院肝胆胰外一科24小时完成2例肝移植

<正>6月17日,吉林大学第一医院肝移植工作再传喜讯,由于心脏死亡器官捐献(DCD)办公室卓有成效的工作,实现了有史以来一天2例DCD捐献。王广义主任领导的肝胆胰外一科肝移植团队在各有关科室及多学科专家的密切配合下,发扬不怕疲劳、无私奉献的精神,连续作战24小时,成功完成肝移植2例。一天同时完成两台肝移植,对医院医疗技术水平及肝移植团队实力是一个巨大考验,对生命垂危的患者来说意义重大,能够     

肝移植治疗原发性肝癌

原发性肝癌曾是肝移植的主要适应证.肝移植的先驱Starzl和Calne最初施行的10例手术中,8例为肝脏恶性病变.但在肝移植用于肝癌治疗的最初实践中,结果令人失望,根据当时美国器官共享网络(UNOS)的数据,其5年生存率低于30%～40%.因而许多学者对肝移植治疗肝癌的价值产生怀疑,以至于在一段时间内对其持消极甚至否定态度,导致肝癌被视为肝移植治疗的相对禁忌证.     

肝移植术后肝癌复发防治进展

肝移植是根治性治疗肝癌的方法之一,但肝移植术后肝癌复发严重影响移植患者的长期生存。通过积极的预防措施,免疫抑制剂调整,早期发现以及全面制订肝癌复发后的干预措施,有助于提高肝癌肝移植患者临床疗效并改善长期生存。为了进一步改善肝移植患者预后,从预防复发及复发后的治疗两大方面对肝移植术后肝癌复发的最新防治进展进行归纳和总结。     

中国肝癌肝移植的现状与展望

肝癌行肝移植治疗的指征、效果和相关问题一直存在争论,国际上已经有数个通用的肝癌肝移植标准,如Milan标准、Pittsburgh标准、UCSF标准等等,中国的移植学家们也在纷纷探讨适合中国的肝癌肝移植标准.本文收集并分析近年来国内外的文献,结合本移植中心460例肝移植的病例,对肝癌的分期标准、晚期肝癌行肝移植的指征进行了探讨,笔者认为影响我国肝癌肝移植的主要因素有:供肝的来源、术后乙肝及肿瘤的复发及相关社会因素等.     

肝癌肝移植转化治疗策略进展

肝移植能够在彻底去除肿瘤的同时完整移除病肝,对于合并肝硬化的肝癌患者是最佳选择。近年来,随着肝癌综合治疗研究的进展,转化治疗理念被引入肝癌外科治疗领域以及肝移植领域,成功的转化治疗有望将超出标准肝癌患者转变为符合标准而接受肝移植手术,从而极大改善其预后。就肝癌肝移植转化治疗的进展进行简要介绍。     

肝移植研究进展——肝移植治疗原发性肝癌

原发性肝癌曾是肝移植的主要适应证。肝移植的先驱Starzl和 Calne最初施行的 10例手术中 ,8例为肝脏恶性病变。但在肝移植用于肝癌治疗的最初实践中 ,结果令人失望 ,根据当时美国器官共享网络 (U NOS)的数据 ,其 5年生存率低于 30 %～ 4 0 %。因而许多学者对肝移植治疗肝癌的价值产生怀疑 ,以至于在一段时间内对其持消极甚至否定态度 ,导致肝癌被视为肝移植治疗的相对禁忌证。反对肝癌行肝移植治疗的主要理由包括 :1移植后免疫抑制状态下的肿瘤复发率高 ,长期生存率低。 2在供肝来源较紧张的情况下 ,仍将有限的供肝移植给疗效不确定的肝…     

中国肝移植供肝获取技术规范(2019版)

肝移植作为各种类型不可逆急、慢性肝病的有效治疗手段,已被广泛接受。经过几十年稳步持续的发展,肝移植技术逐渐成熟和稳定。目前,我国各大移植中心均能完成各项肝移植技术,但存在发展不平衡、技术参差不齐等情况。为进一步规范我国肝移植供肝获取技术,中华医学会器官移植学分会组织肝移植专家,总结国内外相关研究最新进展,并结合国际指南和临床实践,着重针对中国肝移植公民逝世后器官捐献供肝获取技术,制订《中国肝移植供肝获取技术规范(2019版)》。     

双肝移植的临床应用进展

亚洲是乙型肝炎流行高发区,有众多的终末期肝病患者,而肝移植是目前治疗终末期肝病最为有效的手段。由于受传统文化、伦理道德观等观念的影响,尸体器官捐献率一直比较低,器官供需之间的矛盾使得活体肝移植成为挽救终末期肝病患者的重要治疗手段。 双肝移植即一个受体同时接收两个供体的部分肝脏。目前双肝移植绝大多数为活体肝移植。韩国 Lee 等首先报道了双肝移植技术［1］,从两个活体捐献者获得两个肝左叶移植给一个患者。双肝移植由于减少了供体捐肝体积最大程度上保证了供体的安全。     

Liver transplantation for hepatocellular carcinoma: Recent advances in China

Orthotopic liver transplantation is currently the best treatment option for selected patients with hepatocellular carcinoma (HCC). From 1980 to 2011, 8874 patients with HCC in China underwent liver transplantation. The organ donation classification criteria of China (China criteria), which are established by the Government of China, are divided into three parts: China criteria I, donation after brain death; China criteria II, donation after cardiac death and China criteria III, donation after dual brain‐cardiac death. Data from the China Liver Transplant Registry (CLTR) System shows that patients within the Milan criteria have higher survival rates than those who are beyond these criteria. Based on CLTR data, altogether 416 patients received living‐donor liver transplantation (LDLT) in China. Their 1‐year and 3‐year survival rates were significantly higher than those of the non‐LDLT recipients. The most common early stage (<30 days after liver transplantation) complications include pleural effusion, diabetes, peritoneal effusion or abscess, postoperative infection, hypertension and intraperitoneal hemorrhage; while the most common late stage (≥30 days after liver transplantation) complications were diabetes, hypertension, biliary complications, postoperative infection, tacrolimus toxicity and chronic graft rejection. The incidence of vascular complication, which is the main reason for acute graft failure and re‐transplantation, was 2.4%. Liver transplantation is an effective treatment for patients with HCC in China.     

中国肝移植术操作规范(2019版)

肝移植作为各种类型不可逆急、慢性肝病的有效治疗手段,已被广泛接受。经过几十年稳步持续的发展,肝移植技术逐渐成熟和稳定。目前,我国各大移植中心均能完成各项肝移植技术,但存在发展不平衡、技术参差不齐等情况。为进一步规范我国成人肝移植术操作,中华医学会器官移植学分会组织肝移植专家,总结国内外相关研究最新进展,并结合国际指南和临床实践,针对供肝修整、病肝切除、供肝植入以及再次肝移植技术规范化操作,制订《中国肝移植术操作规范(2019版)》。     

Personnel in cadaveric organ transplant-related hospital units faced with living liver donation: an attitudinal study in a Spanish hospital with a cadaveric and living liver transplant programme.

INTRODUCTION: The attitude of health-care personnel is fundamental for the procurement of transplant organs, especially in those services that are related to transplantation. The objective of this study is to find out the attitude towards living liver donation among personnel who work in transplant-related services in a hospital with a cadaveric and living organ transplant programme. MATERIALS AND METHODS: A random sample was taken and stratified by type of service and job category (N=330), in services related to transplantation (procurement units, transplant units and follow-up units). Attitude was evaluated using a validated psychosocial questionnaire. Control group: a random sample of personnel in clinical services that do not have any direct contact with solid organ transplantation. Student's t-test and the chi(2) test complemented by a logistical regression analysis were applied in the statistical analysis. RESULTS: The questionnaire completion rate was 94% (N=309). Only 10% (N=31) of respondents are in favour of living liver donation if it is unrelated, but another 67% (N=207) are in favour if donation were for a relative. Of the rest, 11% (N=33) do not agree with living liver donation and the remaining 12% (N=38) are undecided. In the control group, attitude towards living liver donation is favourable in 82% (N=344) (P=0.0908). An analysis of the variables that influence attitude shows that the following factors are significantly related: (1) age (P=0.037); (2) a respondent's belief that he or she may need a transplant in the future (P=0.013); and (3) if it were necessary, a willingness to receive a donated living liver organ (P=0.000). Of the variables that have the most influence on attitude towards living liver donation in the bivariate analysis, there are two variables that are statistically significant in the multivariate analysis: (1) age and (2) willingness to accept a donated living liver organ from a relative if it were needed (OR=14.19). There is also a close relationship between attitude towards living liver donation and attitude towards living kidney donation (P=0.000) CONCLUSIONS: There is a favourable attitude towards living liver donation among personnel in units related to the transplantation and donation process, although it is less favourable than expected. Therefore, it will be necessary to increase this level of acceptance and to improve information about the matter if we want to encourage living liver donation. The youngest workers in these units are those who are most in favour, which leads us to believe that there is a hopeful future for this type of liver donation that is so necessary given the cadaveric organ deficit.     

A pilot programme of organ donation after cardiac death in China

China's aims are to develop an ethical and sustainable organ transplantation system for the Chinese people and to be accepted as a responsible member of the international transplantation community. In 2007, China implemented the Regulation on Human Organ Transplantation, which was the first step towards the establishment of a voluntary organ donation system. Although progress has been made, several ethical and legal issues associated with transplantation in China remain, including the use of organs from executed prisoners, organ scarcity, the illegal organ trade, and transplantation tourism. In this Health Policy article we outline the standards used to define cardiac death in China and a legal and procedural framework for an organ donation system based on voluntary donation after cardiac death that adheres to both China's social and cultural principles and international transplantation standards.     

Review: Recent advances in liver transplantation

Liver transplant is a life-saving treatment with 1-year and 5-year survival rates of 90% and 70%, respectively. However, organ demand continues to exceed supply, such that many patients will die waiting for an available organ. This article reviews for the general gastroenterologist the latest developments in the field to reduce waiting list mortality and maximise utilisation of available organs. The main areas covered include legislative changes in organ donation and the new ‘opt-out’ systems being rolled out in the UK, normothermic machine perfusion to optimise marginal grafts, a new national allocation system to maximise benefit from each organ and developments in patient ‘prehabilitation’ before listing. Current areas of research interest, such as immunosuppression withdrawal, are also summarised.     

中国肝移植受者选择与术前评估技术规范(2019版)

肝移植作为各种类型不可逆急、慢性肝病的有效治疗手段,已被广泛接受。经过几十年稳步持续的发展,肝移植技术逐渐成熟。随着肝移植技术的发展、新型免疫抑制剂的应用以及围手术期管理的进步,肝移植适应证和禁忌证也在发生变化。详细的术前检查和准备是保证肝移植预后的重要环节。为进一步规范我国肝移植受者选择以及术前评估和准备,中华医学会器官移植学分会组织肝移植专家,总结国内外相关研究最新进展,结合国际指南和临床实践,从肝移植适应证和禁忌证、受者术前检查、术前准备以及常见并发症处理等方面,制订《中国肝移植受者选择与术前评估技术规范(2019版)》。     

Liver transplantation in the UK

Introduction:This paper provides a review of the practiceof liver transplantation with the main emphasis on UKpractice and indications for transplantation.Referral and Assessment:This section reviews theprocess of referral and assessment of patients with liverdisease with reference to UK practice.Donor Organs:The practice of brainstem death andcadaveric organ donation is peculiar to individualcountries and rates of donation and potential areas ofimprovement are addressed.Operative Technique:The technical innovations that haveled to liver transplantation becoming a semi-electiveprocedure are reviewed.Specific emphasis is made to therole of liver reduction and splitting and living related livertransplantation and how this impacts on UK practice arereviewed.The complications of liver transplantation arealso reviewed with reference to our own unit.Immunosuppression:The evolution ofimmunosuppression and its impact on liver transplantationare reviewed with some reference to future protocols.Retransplantation:The role of retransplantation isreviewed.Outcome and Survival:The results of liver transplantationare reviewed with specific emphasis on our ownexperience.Future:The future of liver transplantation is addressed.     

Liver transplantation in Italy: current status

The first liver transplant in Italy was performed in 1982. With the improvement in results, the number of patients followed, in recent years, has substantially increased in all centres. In parallel, the indications for liver transplantation have expanded and have raised the need for more organized structures where patients can be referred for evaluation and transplantation. Indications and contraindications to liver transplantation in Italy, the role of retransplantation, paediatric liver transplantation, waiting list management, liver transplantation outside Italy and the new Italian laws on organ donation are discussed. The multidisciplinary Study Group on Liver Transplantation of the Italian Association for the Study of the Liver (AISF) has collected information from all the Italian centres to ascertain the degree of consistency in their methods.     

Debate on live related liver transplant: Pro

Abstract   Live donor liver transplantation (LDLT) in adults is life saving for patients with fulminant hepatic failure, acute on chronic liver failure and end-stage cirrhosis, particularly in Asia where cadaveric organ donation is scarce. Without this modality, 50% of adult patients waiting for deceased donor liver grafts and 95% of patients with fulminant hepatic failure died. With right lobe LDLT, the overall survival rate of patients with fulminant hepatic failure increases from 5–50% and the transplant rate of patients waiting for deceased donor grafts increased from 13–42%.