边缘性供体肝移植的研究进展

Updates on extended criteria donor for liver transplantation

肝移植作为终末期肝病的唯一治愈性手段,取得了良好的疗效,但供肝短缺一直是制约肝移植发展的最大瓶颈。边缘性供体(ECD)肝脏的使用可在一定程度上缓解供肝短缺的矛盾,成为现阶段我国肝移植工作必须面对的问题。供肝质量是决定移植效果和受体安全的决定性因素,而ECD供肝因为具有各种各样的缺陷,其选择和使用尤其需要谨慎。这就要求肝移植外科医师在对ECD供肝的危险因素和评判标准充分了解的基础上,结合受体情况做出供肝选择决策。本文探讨了ECD供肝的危险因素、评判标准、分配使用和机械灌注技术的应用,并讨论了ECD研究的根本问题和发展前景。

Though achieved great success as the only curative treatment for end-stage liver diseases, liver transplantation has been severely restricted by the shortage of donors. The adoption of extended criteria donor (ECD) tackles the donor shortage problem to some extent, thus became an issue we must face in China at present stage. As the transplantation effect and recipient safety is largely decided by the quality of liver graft, ECD graft should be cautiously selected and adopted because of its inherent defects. This relies on individualized decisions made for recipients by transplant surgeons who have a good understanding of the risk factors and evaluation criteria of ECD. In this article, we investigate the risk factors, evaluation criteriaand allocation of ECD liver grafts as well as the application of mechanic perfusion, and we discuss the fundamental issues and prospects of ECD study.