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中华移植杂志(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 193 -204. doi: 10.3877/cma.j.issn.1674-3903.2023.04.001

所属专题: 指南共识

专家共识

肝移植受者雷帕霉素靶蛋白抑制剂临床应用中国专家共识(2023版)
中国器官移植发展基金会器官移植受者健康管理专家委员会, 中国医师协会器官移植医师分会, 中华医学会器官移植学分会, 国家肝脏移植质控中心   
  • 收稿日期:2023-07-03 出版日期:2023-08-25
  • 基金资助:
    中国器官移植发展基金会器官移植受者健康管理专项基金(COTDF-020004)

Chinese expert consensus on clinical application of inhibitors of mammalian target of rapamycin in liver transplant recipients (2023 edition)

Committee of Health Management for Organ Transplant Recipient, China Organ Transplantation Development Foundation, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association, Branch of Organ Transplant of Chinese Medical Association, National Center for Healthcare Quality Management in Liver Transplant   

  • Received:2023-07-03 Published:2023-08-25
引用本文:

中国器官移植发展基金会器官移植受者健康管理专家委员会, 中国医师协会器官移植医师分会, 中华医学会器官移植学分会, 国家肝脏移植质控中心. 肝移植受者雷帕霉素靶蛋白抑制剂临床应用中国专家共识(2023版)[J/OL]. 中华移植杂志(电子版), 2023, 17(04): 193-204.

Committee of Health Management for Organ Transplant Recipient, China Organ Transplantation Development Foundation, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association, Branch of Organ Transplant of Chinese Medical Association, National Center for Healthcare Quality Management in Liver Transplant. Chinese expert consensus on clinical application of inhibitors of mammalian target of rapamycin in liver transplant recipients (2023 edition)[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2023, 17(04): 193-204.

肝移植是治疗终末期肝病最有效的方法。随着外科技术和免疫抑制药物的发展,肝移植受者和移植物生存率已显著提高。根据中国肝移植注册中心(China Liver Transplant Registry,CLTR)数据,2015至2021年我国共实施肝移植35 566例,公民逝世后器官捐献肝移植和活体肝移植受者术后1、3、5年生存率分别为83.7%、74.5%、68.9%和92.4%、89.3%、88.2%[1]。肝移植受者的长期存活和生存质量很大程度上取决于术后中长期健康管理和免疫抑制方案。长期服用免疫抑制剂可导致受者出现肾损伤、代谢性疾病和新发恶性肿瘤等严重并发症,甚至增加肝癌肝移植术后肿瘤复发风险[2]。目前肝移植受者常用的免疫抑制方案以钙调磷酸酶抑制剂(calcineurin inhibition,CNI)为基础,其中以他克莫司+吗替麦考酚酯(mycophenolate mofetil,MMF)+泼尼松方案最为普遍。但是CNI引起的肾脏毒性、神经毒性和促进肿瘤复发等问题极大地影响了受者预后,近年来临床逐渐减少其用量并寻求替代药物。

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[3] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[4] 高建新, 王啸飞, 于淼, 路夷平. 局部进展期直肠癌新辅助治疗后行ISR术远切缘距离的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 539-543.
[5] 胡宁宁, 赵延荣, 王栋, 王胜亮, 郭源. FMNL3与肝细胞癌肝移植受者预后的相关性研究[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 283-288.
[6] 仲福顺, 余露, 范晓礼, 叶啟发. 肝移植治疗肝上皮样血管内皮瘤一例[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 293-297.
[7] 刘冉佳, 崔向丽, 周效竹, 曲伟, 朱志军. 儿童肝移植受者健康相关生存质量评价的荟萃分析[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 302-309.
[8] 贺健, 张骊, 王洪海, 蒋文涛. 肝移植术后脾功能亢进转归及治疗研究进展[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 310-314.
[9] 王淑贤, 张良灏, 王利君, 张慧, 郭源, 许传屾, 李志强, 蔡金贞, 解曼, 饶伟. 成人肝移植围手术期严重心血管事件危险因素分析及预测模型研究[J/OL]. 中华移植杂志(电子版), 2024, 18(04): 222-229.
[10] 魏志鸿, 刘建勇, 吴小雅, 杨芳, 吕立志, 江艺, 蔡秋程. 肝移植术后急性移植物抗宿主病的诊治(附四例报告)[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 846-851.
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[12] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[13] 中华医学会器官移植学分会, 中华医学会外科学分会外科手术学学组, 中华医学会外科学分会移植学组, 华南劈离式肝移植联盟. 劈离式供肝儿童肝移植中国临床操作指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 593-601.
[14] 刘军, 丘文静, 孙方昊, 李松盈, 易述红, 傅斌生, 杨扬, 罗慧. 在体与离体劈离式肝移植在儿童肝移植中的应用比较[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 688-693.
[15] 张英信, 林婷, 张剑文. 构建靶向HLA-A2且表达PD-L1的CAR-Treg细胞及验证其对CD4+T细胞抑制作用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 719-728.
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