肝移植免疫抑制治疗及药物使用现状与研究进展

Current Status and Advances in Immunosuppressive Therapy and Drug Use for Liver Transplantation

肝移植是目前公认的治疗急性肝衰竭、慢性终末期肝病、肝脏肿瘤等严重肝病最有效的方法。随着临床外科手术技术的成熟和围手术期管理水平的提升,肝移植手术成功率明显升高;而随着免疫研究的不断深入,以及免疫抑制药物使用的规范,免疫抑制治疗取得了显著的临床疗效,肝移植术后移植物和受体存活时间不断延长。然而,随着免疫抑制剂的长期使用,患者的代谢综合征、心血管并发症、新发恶性肿瘤、肾功能异常等风险发生率逐渐增高,这严重影响着患者的长期预后。临床上,肝移植术后免疫抑制治疗必须充分考虑抑制移植排斥反应与避免免疫抑制药物不良反应之间的平衡,优化免疫治疗方案和诱导免疫耐受是肝移植免疫治疗的研究热点。对肝移植排斥反应特点、肝移植免疫抑制药物使用现状、肝移植免疫抑制治疗研究进展进行综述,并展望肝移植免疫抑制治疗研究前景。

Liver transplantation is currently recognized as the most effective method for the treatment of severe liver diseases such as acute liver failure,chronic end-stage liver disease,and liver tumor.With the improvement in clinical surgical techniques and perioperative management, the success rate of liver transplantation has increased significantly.With the development of immunological research and the standardized use of immunosuppressants,the immunosuppressive therapy of liver transplantation has achieved remarkable clinical effect,and the survival time of grafts and the recipients after liver transplantation are prolonged.However,with the long-term use of immunosuppressants,the risk of metabolic syndrome,cardiovascular complications,new malignant tumors and abnormal renal function is gradually increasing,which seriously affects the long-term prognosis of patients.Clinically,the balance between reducing the risk of rejection of liver transplantation and avoiding the adverse reactions of immunosuppressants should be given full consideration in the immunosuppressive therapy after liver transplantation.Optimization of immunotherapy regimen and induction of immune tolerance are the research focus of immunotherapy for liver transplantation.In this paper,the characteristics of rejection,the use of immunosuppressive drugs,and the research progress in immunosuppressive therapy for liver transplantation were reviewed,and the research prospect of immunosuppressive therapy for liver transplantation was introduced.