The Chinese clinical practice guideline on liver transplantation for hepatocellular carcinoma (2014 edition)

  • 摘要: 肝移植是被全世界认可的治疗终末期肝病的有效手段之一。目前,肝移植在全国范围内已得到广泛开展,亟待相关临床实践指南来指导全国肝移植工作更规范、有效、安全地开展。中华医学会器官移植学分会、中华医学会外科学分会移植学组及中国医师协会器官移植医师分会组织专家制订了《中国肝癌肝移植临床实践指南(2014版)》,重点阐述肝移植受者选择标准、术前降期治疗、受者抗病毒治疗、受者免疫抑制剂应用、术后肿瘤复发的防治5部分内容。米兰标准是肝癌肝移植受者选择的参考基准,而杭州标准是对米兰标准局限于肿瘤形态学的巨大突破。肝癌肝移植术前肿瘤降期治疗可使不满足肝癌肝移植受者选择标准的患者能够被纳入移植标准,获得肝移植机会。对于乙型病毒性肝炎肝癌肝移植受者行抗病毒治疗,有助于降低移植术后乙型病毒性肝炎复发率,提高受者长期生存率。目前主张个体化的低剂量免疫抑制方案以达到最大限度保护移植肝脏功能,同时减轻其毒副作用,减少移植后肝癌复发。肝癌肝移植术后复发的防治可采用手术、TACE、局部消融以及放射免疫、靶向治疗、系统性化疗等手段,为受者制订个体化治疗方案。

     

    Abstract: Liver transplantation is still one of the most effective treatments for endstage liver diseases. Presently,liver transplantation has been widely carried out around China, and a clinical practice guideline is necessary for more standard, effective and safer application of liver transplantation. Therefore, the Chinese clinical practice guideline on liver transplantation for hepatocellular carcinoma (HCC) was developed by the experts from Chinese Society of Organ Transplantation; Section of Organ Transplantation, Chinese Society of Surgery; Chinese College of Transplant Doctors. The Chinese clinical practice guideline on liver transplantation for HCC mainly focused on the following 5 parts: recipients selection criteria for liver transplantation, preoperative downstaging treatments, antiviral therapies, applications of immunosuppressant and postoperative treatment for prevention of HCC recurrence. Milan criteria are regarded as the international standard for selecting recipients, while the Hangzhou criteria are a breakthrough for the Milan criteria which is limited to tumor morphology. For patients who are not candidates for liver transplantation or resection, a variety of downstaging treatments can be offered to help them get the chance for liver transplantation. For recipients with hepatitis B virus (HBV) infection, the antiviral treatment should be initiated with the aim to reduce the rate of HBV recurrence after liver transplantation and improve the longterm survival of recipients. Meanwhile, tailored immunosuppression is recommended with the aim of achieving optimal graft function while avoiding undesirable side effects and the recurrence of HCC. For the treatment of HCC recurrence after liver transplantation, several methods including surgery, transcatheter arterial chemoembolization, regional ablation, radioimmunotherapy, target therapy and systemic chemotherapy could be selected for designing the individualized treatment.

     

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