肝移植围手术期血管并发症诊治专家共识(2021版)

Expert consensus on perioperative vascular complications for liver transplantation(2021)

肝移植术后血管并发症是造成移植肝功能障碍和移植物丢失的重要原因之一,发生率为5%~25%,病死率高。供受者复杂多变的血管条件、吻合技术、感染和移植后急慢性排斥反应等,均可引起肝移植血管并发症。血管并发症的类型多元、复杂,按血管构造可分为动脉并发症和静脉并发症;按血流特征可分为流入道(肝动脉、门静脉)障碍和流出道(肝静脉、腔静脉)障碍;按病变性质可分为破裂出血、狭窄、血栓形成及假性动脉瘤等;按发生时段可分为早期和晚期。手术方案设计与外科操作技术等,是治疗肝移植术后早期血管并发症的技术因素;而血管并发症的类型及其伴随的临床表现与诊治策略的选择及临床转归密切相关。因此,中华医学会器官移植学分会围手术期管理学组特制定《肝移植围手术期血管并发症诊治专家共识(2021版)》,旨在规范与优化肝移植受者围手术期常见血管并发症的临床诊治。

Vascular complications after liver transplantation are important causes of liver dysfunction and graft loss.The incidence rate range is from 5%to 25%,and the mortality rate is high.The complex and changeable vascular conditions of the donor and recipient,anastomosis techniques,infection,and acute and chronic rejection after transplantation can all cause vascular complications of liver transplantation.The types of vascular complications are diverse and complex.According to the vascular structure,they can be divided into arterial and venous complications;according to the characteristics of blood flow,they can be divided into inflow tract(hepatic artery,portal vein)or outflow tract(hepatic vein,vena cava)disorders;according to the nature of the lesion,they can be divided into rupture,stenosis,thrombosis and pseudoaneurysm,etc;according to the time of occurrence,they can be divided into early or late.Surgical plan design and surgical operation techniques are the technical factors of early vascular complications after liver transplantation.The types of vascular complications and their accompanying clinical manifestations are closely related to the choice of diagnosis and treatment strategies and clinical outcomes.Therefore,the Perioperative Management Group of Chinese Society of Organ Transplantation of Chinese Medical Association formulated the Expert Consensus on Diagnosis and Treatment of Perioperative Vascular Complications of Liver Transplantation,aiming to standardize and optimize the clinical diagnosis and treatment of common perioperative vascular complications in liver transplant recipients.