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中华移植杂志(电子版) ›› 2026, Vol. 20 ›› Issue (03) : 201 -210. doi: 10.3877/cma.j.issn.1674-3903.2026.03.009

综述

慢加急性肝衰竭肝移植的时机选择及预后因素探讨
谢琴芬1,2, 王硕1, 杨煜1, 郑树森1,2,()   
  1. 1310022 杭州,浙江树人学院树兰国际医学院附属树兰杭州医院肝胆胰外科,全省人工器官与计算医学重点实验室
    2310058 杭州,浙江大学医学院
  • 收稿日期:2025-10-06 出版日期:2026-06-25
  • 通信作者: 郑树森
  • 基金资助:
    全省人工器官与计算医学重点实验室开放/自主基金(SZD2025B025)

Timing and prognostic factors of liver transplantation in acute-on-chronic liver failure

Qinfen Xie1,2, Shuo Wang1, Yu Yang1, Shusen Zheng1,2,()   

  1. 1Department of Hepatobiliary and Pancreatic Surgery, Key Laboratory of Artificial Organs and Computational Medicine of Zhejiang Province, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou 310022, China
    2Zhejiang University School of Medicine, Hangzhou 310058, China
  • Received:2025-10-06 Published:2026-06-25
  • Corresponding author: Shusen Zheng
引用本文:

谢琴芬, 王硕, 杨煜, 郑树森. 慢加急性肝衰竭肝移植的时机选择及预后因素探讨[J/OL]. 中华移植杂志(电子版), 2026, 20(03): 201-210.

Qinfen Xie, Shuo Wang, Yu Yang, Shusen Zheng. Timing and prognostic factors of liver transplantation in acute-on-chronic liver failure[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2026, 20(03): 201-210.

慢加急性肝衰竭(ACLF)是在慢性肝病基础上因感染、酒精滥用等诱因导致的急性失代偿严重综合征,特征为肝功能急剧恶化伴多器官功能衰竭,短期死亡风险高。目前缺乏有效的治疗手段,肝移植是唯一可能挽救患者生命的干预措施,在严格筛选条件下可获得良好疗效,但预后受多种因素影响。ACLF高发病率、供肝持续短缺及移植适应证不断扩展,使得肝移植在ACLF中的应用仍存在争议。本文围绕ACLF病因、诊断和预测模型,系统分析其肝移植应用现状、死亡预测因素、受者选择和最佳移植时机证据,以期为临床决策提供参考。

Acute-on-chronic liver failure (ACLF) is a severe syndrome characterized by acute decompensation due to triggers such as infection or alcohol abuse in patients with chronic liver disease, marked by rapid deterioration of liver function accompanied by multiple organ failure and high short-term mortality. Effective therapeutic options are currently lacking, and liver transplantation remains the only life-saving intervention, which can achieve favorable outcomes in strictly selected patients, although prognosis is influenced by multiple factors. Given the high incidence of ACLF, persistent shortage of donor livers, and expanding indications for liver transplantation, the role of liver transplantation in ACLF remains controversial. This article reviews the etiology, diagnosis, and prognostic models of ACLF, and systematically analyzes the current status of liver transplantation application, predictors of post-transplant mortality, recipient selection, and evidence for optimal timing, aiming to provide references for clinical decision-making.

表1 ACLF患者肝移植预后相关研究汇总
作者 研究时间(年) ACLF 1/2/3级(例) 移植后存活率(%,ACLF 1/2/3级)
遗体器官捐献      
Artru等[6] 2008~2014 3级:73 1年:3级83.6
Kwon等[33] 2008~2019 120/129/140 1年:3级67.9;所有分级:5年57.6
Zhu等[34] 2018~2020 75/64/73 1年:93.3/73.4/60.3
Xia等[35] 2015~2021 18/97/47 1年:83.0/83.2/69.8; 3年:83.0/80.3/69.8
Cervantes-Alvarez等[36] 2015~2019 40/33/22 1年:87.5/97.0/90.9; 6年:80.0/93.9/77.3
Goosmann等[37] 2009~2014 所有分级:98 所有分级:5年55.1
Agbim等[38] 2006~2013 50/32/19 1年:86/81/74
Marciano等[39] 2010~2016 34/18/8 1年:82.3/100.0/ 62.5
Levesque等[40] 2008~2013 68/42/30 1年:76.5/78.6/43.3
Michard等[41] 2007~2014 所有分级:55 所有分级:1年60
Finkenstedt等[42] 2002~2010 所有分级:33 所有分级:1年87, 5年82
Xing等[43] 2001~2009 所有分级:133 所有分级:1年75.9, 5年72.1
Thuluvath等[44] 2002~2016 4 330/3 557/3 556 1年:88/88/83; 5年:74/74/70
Sundaram等[45] 2005~2016 7 375/7 513/6 381 1年:89.1/88.1/81.8
Sundaram等[46] 2004~2017 8 757/9 039/7 981 1年:89.5/88.6/80.6; 5年:75.2/74.9/67.7
Belli等[47] 2018~2019 58/78/98 1年:1级88.6, 3级78.9
Sundaram等[48] 2018~2019 61/74/77 1年:88.5/87.8/85.7
Alukal等[49] 2005~2021 3级:4 806 1年:3级86.2
Bernal等[50] 2021~2023 3级:42 1年:3级77
Artru等[51] 2008~2014 3级:73 5年:76.4/69.7/72.6
Artzner等[52] 2018~2019 3级:98 1年:3级79
Sundaram等[53] 2002~2014 3级:2 349 1年:3级79.8
Hernaez等[54] 2014~2019 0/237/284 1年:2级84.4, 3级76.4
Artzner等[55] 2007~2017 3级:152 1年:3级67.1
Huebener等[56] 2009~2014 24/45/29 所有分级:3个月72.4, 2年60.2
活体器官捐献      
Kwon等[33] 2008~2019 261/147/75 1年:3级72.0; 5年:67.5
Kulkarni等[57] 2019~2021 所有分级:55 所有分级:1年72.7
Moon等[58] 1998~2015 96/43/51 1年:81.3/72.3/76.0; 5年:75.0/68.0/71.5
Vu等[59] 2019~2022 5/35/11 所有分级:1年81.7, 3年81.7
Bhatti等[60] 2012~2022 45/40/19 1年:68.9/75.0/73.7
表2 ACLF患者肝移植后死亡风险预测因素
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