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中华移植杂志(电子版) ›› 2025, Vol. 19 ›› Issue (06) : 375 -384. doi: 10.3877/cma.j.issn.1674-3903.2025.06.001

标准与指南

中国肝移植大肝综合征临床诊治指南(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. 四川大学华西医院,610041 成都
    2. 国家肝脏移植技术医疗质量控制中心,310006 杭州
    3. 郑州大学附属第一医院,450052 郑州
    4. 复旦大学附属华山医院,200040 上海
  • 收稿日期:2025-09-10 出版日期:2025-12-25
  • 基金资助:
    四大慢病重大专项(2023ZD0502400); 国家科技重大专项(2022YFC2304705); 国家自然科学基金项目(82270691,82570743,82300663,82500725); 四川大学华西医院学科卓越发展1·3·5工程项目(ZYGD24002)

Chinese clinical practice guideline for prevention and treatment of large-for-size syndrome in liver transplantation (2025 edition)

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

  1. 1. West China Hospital of Sichuan University, Chengdu 610041, China
    2. National Center for Healthcare Quality Management of Liver Transplant, Hangzhou 310006, China
    3. the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
    4. Huashan Hospital, Fudan University, Shanghai 200040, China
  • Received:2025-09-10 Published:2025-12-25
引用本文:

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. 中国肝移植大肝综合征临床诊治指南(2025版)[J/OL]. 中华移植杂志(电子版), 2025, 19(06): 375-384.

Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association. Chinese clinical practice guideline for prevention and treatment of large-for-size syndrome in liver transplantation (2025 edition)[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2025, 19(06): 375-384.

在肝移植临床实践中,尤其是面对小体重受者时,因适配供肝资源有限,临床往往不得不采用体积相对较大的供肝以完成移植。然而,此类供受者体积不匹配肝移植显著增加术后大肝综合征(LFSS)发生风险。LFSS是指因供肝体积或厚度相对过大,导致腹腔嵌塞、门静脉灌注受限、肝静脉回流障碍及移植物功能损害的一组综合征,婴幼儿患者尤为多见,处理难度大,并发症发生率高。为指导临床科学识别、有效预防与规范干预LFSS,中华医学会器官移植学分会肝移植学组与中国医师协会器官移植医师分会组织国内相关专家,在系统调研国内外研究进展基础上,制订《中国肝移植大肝综合征临床诊治指南(2025版)》。本指南依循2009年牛津大学循证医学证据分级体系,从LFSS的定义和临床表现、关键评估指标、手术预防策略、术后监测及多学科协作干预等方面,提出系统性推荐意见。指南强调"预防为主、干预为辅"的治疗理念,倡导供受者个体化匹配与精细化外科操作,旨在规范LFSS临床管理路径,提升我国肝移植整体安全性与成功率,推动成人及儿童肝移植技术高质量发展。

In clinical liver transplantation practice, particularly when dealing with low body weight recipients, the limited availability of size-matched donor grafts often necessitates the use of relatively large grafts to complete the transplantation. However, such graft-to-recipient size mismatch significantly increases the risk of developing large-for-size syndrome (LFSS) after liver transplantation. LFSS refers to a spectrum of complications resulting from excessive graft volume or thickness, leading to intra-abdominal compartmentalization, portal venous inflow restriction, hepatic venous outflow obstruction, and impaired graft function. It is especially prevalent in infant recipients, where management is more complex and associated with higher complication rates. To guide accurate clinical recognition, effective prevention, and standardized intervention of LFSS, the Liver Transplantation Group, Branch of Organ Transplant of the Chinese Medical Association and the Branch of Organ Transplant Physicians of the Chinese Medical Doctor Association convened national experts to develop the Chinese clinical practice guideline for prevention and treatment of large-for-size syndrome in liver transplantation (2025 edition), based on a comprehensive review of international and domestic research advances. The guideline adopts the 2009 Oxford Centre for Evidence-Based Medicine levels of evidence system and provides structured recommendations covering the definition and clinical manifestations of LFSS, key assessment parameters, surgical preventive strategies, postoperative monitoring, and multidisciplinary interventions. Emphasizing a "prevention-focused, intervention-supported" therapeutic principle, the guideline advocates for individualized graft-recipient matching and refined surgical techniques. Its implementation aims to standardize LFSS clinical management, enhance the overall safety and success rate of liver transplantation in China, and promote high-quality development of both adult and pediatric liver transplant techniques.

表1 2009牛津大学循证医学中心证据分级与推荐意见强度分级标准
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