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中华移植杂志(电子版)

中华移植杂志(电子版) ›› 2025, Vol. 19 ›› Issue (02) : 65 -75. doi: 10.3877/cma.j.issn.1674-3903.2025.02.001

标准与指南

中国扩大标准供肝移植临床应用指南(2025版)
中华医学会器官移植学分会肝移植学组, 中国医师协会器官移植医师分会   
  1. 1. 国家肝脏移植技术医疗质量控制中心，浙江大学器官移植研究所，310000　杭州
    2. 四川大学华西医院器官移植中心，610041　成都
    3. 复旦大学附属华山医院普外科肝脏移植中心，200040　上海
  • 收稿日期:2025-04-09 出版日期:2025-04-25
  • 基金资助:
    国家重点研发计划(2021YFA1100500); 杭州医学院领军创新团队-器官移植临床研究(CXLJ202401); 国家自然科学基金面上项目(82470683); 浙江省"尖兵""领雁"研发攻关计划(2022C03108)

Chinese clinical practice guidelines for extended criteria donor grafts in liver transplantation

Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association   

  1. 1. National Center for Healthcare Quality Management of Liver Transplant, the Institute of Organ Transplantation, Zhejiang University, Hangzhou 310000, China
    2. West China Hospital of Sichuan University, Chengdu 610041, China
    3. Liver Transplantation Center, Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
  • Received:2025-04-09 Published:2025-04-25
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中华医学会器官移植学分会肝移植学组, 中国医师协会器官移植医师分会. 中国扩大标准供肝移植临床应用指南(2025版)[J/OL]. 中华移植杂志(电子版), 2025, 19(02): 65-75.

Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association. Chinese clinical practice guidelines for extended criteria donor grafts in liver transplantation[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2025, 19(02): 65-75.

供器官匮缺严重制约了器官移植的临床应用。心脏死亡器官捐献供肝、脂肪变性供肝等扩大标准供肝在我国肝移植领域中的应用逐年增加，导致移植术后早期移植肝功能不全等并发症发生率显著升高，受者总体生存率显著降低。为规范扩大标准供肝的临床应用并提升肝移植疗效，中华医学会器官移植学分会肝移植学组和中国医师协会器官移植医师分会组织专家，系统汇总分析国内外循证医学证据，结合我国临床实践经验，制订了《中国扩大标准供肝移植临床应用指南(2025版)》。本指南针对心脏死亡器官捐献供肝、脂肪变性供肝、小体积供肝、高龄供肝及乙型肝炎病毒感染供肝等多类扩大标准供肝，从供受者状态及危险因素防范等方面提出系统性的推荐意见，旨在建立科学的扩大标准供肝评估与应用体系，平衡器官使用风险与移植获益，提高我国肝移植受者总体生存率和生活质量。

关键词: 肝移植, 扩大标准供肝, 临床应用

Severe donor organ shortage has greatly restricted the clinical application of organ transplantation. In China, the utilization of extended criteria donor (ECD) grafts, including donation after cardiac death (DCD) and steatotic grafts have increased year by year, leading to a significantly higher incidence of early allograft dysfunction and other post-transplant complications, as well as a significantly reduced overall survival. To standardize the clinical use of ECD grafts and improve recipients′ outcome, the Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association and Organ Transplantation Physicians of the Chinese Medical Doctor Association have organized experts to summarize and discuss the clinical diagnosis and management of ECD grafts in China by combining the evidence-based medical basis and Chinese clinical practice experience, and by drawing on the relevant domestic and international literature, thereby developed the "Chinese Clinical Practice Guidelines for Extended Criteria Donor Grafts in Liver Transplantation." This guideline addressed a series of recommendations in a scientific and standardized way in terms of donor-recipient status and risk prevention, regarding to DCD grafts, steatotic grafts, small-for-size grafts, elderly donor grafts, and hepatitis B virus-infected grafts. Its purpose is to establish a scientific evaluation and application framework for ECD grafts, balance the risks of organ utilization and survival benefits, and ultimately enhance overall survival and life quality of liver transplant recipients in China.

Key words: Liver transplantation, Extended criteria donor liver, Clinical application
表1 扩大标准供肝主要类型
1 DCD供肝或DBCD供肝(功能性热缺血时间>20 min)
2 大泡性脂肪变>30%肝脏或捐献者身体质量指数>30 kg/m2
3 小体积肝脏(移植物重量与受者体重比值<0.8%或供肝体积与受者标准肝脏体积比值<40%)
4 年龄>65岁的捐献者供肝
5 肝炎病毒感染捐献者肝脏
6 脑死亡捐献者在ICU停留时间>7 d，且获取时有多器官功能不全，血清总胆红素和转氨酶持续高于正常上限3倍以上
7 其他，包括：冷/热缺血时间延长、ABO血型不相容、高钠血症、血流动力学不稳定、不明原因死亡、活动性感染及高风险生活方式等捐献者肝脏
表2 牛津循证医学中心2009版证据等级质量与推荐意见强度分级标准
推荐强度 证据等级 描述
A 1a RCTs的系统评价
  1b 结果可信区间小的RCT
  1c 显示"全或无效应"的任何证据
B 2a 队列研究的系统评价
  2b 单个的队列研究(包括低质量RCT，如失访率>20%者)
  2c 基于患者结局的研究
  3a 病例对照研究的系统评价
  3b 单个病例对照研究
C 4 病例报道、低质量队列研究和低质量病例对照研究
D 5 专家意见(即无临床研究支持的仅依据基础研究或临床经验的推测)
表3 乙型肝炎病毒不同感染状态的血清学特征
血清学检测 感染状态
HBsAg阳性 急性感染
HBsAb阴性  
HBcAb阳性  
HBcAb IgM阳性  
HBsAg阳性 慢性感染
HBsAb阴性  
HBcAb阳性  
HBcAb IgM阴性  
HBsAg阴性 既往感染
HBsAb阴性或阳性  
HBcAb阳性  
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