慢加急性肝衰竭肝移植围手术期康复评估与干预专家共识

Expert consensus on liver transplantation perioperative evaluation and rehabilitation for acute-on-chronic liver failure

尽管肝移植能治愈慢加急性肝衰竭(ACLF),但ACLF患者在肝移植围手术期面临多器官系统衰竭和术后并发症风险高等问题,严重影响移植疗效。近年来,急危重症、肝病和外科领域的早期康复使得患者器官储备功能和手术耐受能力显著提升,术后生存质量也得到了显著改善,这些理念也在ACLF肝移植围手术期得到很好的实践。为此,在中国医师协会器官移植医师分会移植免疫学专业委员会、中国康复医学会器官移植康复专业委员会和广东省医师协会器官移植医师分会的共同倡导下,通过文献证据总结,结合临床最佳实践,对肝移植围手术期综合康复措施进行了广泛探讨,在心肺和躯体康复的评估、干预以及其实施安全性达成了一定共识,为肝脏内科、移植科和重症医学科临床医师提供有价值的参考。

Acute-on-chronic liver failure(ACLF)can be cured by liver transplantation;however,perioperative complications still affect posttransplant outcomes.In recent years,early rehabilitation for critical illness,liver disease,and surgery have significantly improved organ reserve function,surgery tolerance,and postoperative quality of life.They could also be applied in the perioperative period of liver transplantation in patients with ACLF.Therefore,the Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association,the Organ Transplant Rehabilitation Committee of China Association Rehabilitation Medicine,and the Branch of Organ Transplantation Physician of Guangdong Medical Doctor Association conducted a comprehensive review of rehabilitation in end-stage liver disease,critical illness and surgical patients by summarizing current evidence and best clinical practices and proposed a practice consensus on evaluation of cardiopulmonary and physical function,rehabilitation or physiotherapies,as well as the safety concerns in perioperative liver transplant recipients.It will be a valuable resource for hepatologists,transplant surgeons,and intensivists as they care for ACLF patients during transplantation.