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首页> 外文期刊>Current opinion in gastroenterology >Liver transplantation: an update 2009.
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Liver transplantation: an update 2009.

机译：肝移植：2009年更新。

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PURPOSE OF REVIEW: In this review we focus on three challenging aspects of liver transplantation: living donor liver transplant, transplantation in HIV-positive recipients and down-staging of hepatocellular carcinoma for liver transplantation. RECENT FINDINGS: The adult-to-adult living donor liver transplantation cohort study is providing valuable information on recipient and donor outcomes associated with living donor liver transplantation. The recipient outcomes with living donor liver transplantation are comparable to those with deceased donor liver transplantation for most diseases, but increased hepatocellular carcinoma recurrence has been reported with living donor liver transplantation. Donor morbidity is not infrequent and donor mortality remains a concern. Liver transplantation for HIV-positive recipients is associated with equivalent outcomes as HIV-negative recipients for selected recipients. Transplantation in coinfected recipients (HIV and HCV+) is associated with less favorable outcomes. Drug interaction between immunosuppression and highly active antiretroviral therapy is increasingly recognized and requires major modifications in dosing. Down-staging hepatocellular carcinoma to within transplant criteria is being used in some centers using loco-regional therapy. Waiting time after loco-regional therapy is currently the best predictor of recurrence. The role of newer chemotherapeutics is being tested as part of neoadjuvant therapy after resection or loco-regional therapy. SUMMARY: Living donor liver transplantation is a viable strategy to increase transplantation and reduce death on the waiting list. Donor morbidity should be the subject of further efforts to minimize these risks. The increased recurrence risk with living donor liver transplantation for hepatocellular carcinoma warrants further study. Careful coordination between transplant professionals and HIV experts is necessary to monitor issues of posttransplant care of the HIV-infected recipient. The role of loco-regional therapies in down-staging patients with hepatocellular carcinoma is expanding.
机译：审查的目的：在这篇综述中，我们着眼于肝移植的三个挑战性方面：活体供体肝移植，HIV阳性受体的移植和肝细胞肝癌的降级。最新发现：成人到成人的活体供肝移植队列研究正在提供与活体供体肝移植相关的受体和供体结果的有价值的信息。在大多数疾病中，活体供体肝移植的受体结果与已死者的供体肝移植的结果相当，但是据报道活体供体肝移植的肝细胞癌复发增加。供体发病率并不罕见，并且供体死亡率仍然是一个问题。 HIV阳性接受者的肝移植与选定接受者的HIV阴性接受者具有同等的结局。在合并感染的受者（HIV和HCV +）中移植与不良预后相关。免疫抑制和高活性抗逆转录病毒疗法之间的药物相互作用已得到越来越多的认识，并且需要对剂量进行重大修改。在一些使用局部区域疗法的中心，正在将肝细胞癌的分级降低到移植标准之内。局部治疗后的等待时间目前是复发的最佳预测指标。切除或局部区域治疗后，作为新辅助治疗的一部分，正在测试新型化学疗法的作用。摘要：活体供体肝移植是增加移植并减少等待者死亡的可行策略。供体发病率应成为进一步努力以减少这些风险的主题。活体供体肝移植治疗肝细胞癌增加的复发风险值得进一步研究。移植专业人员和HIV专家之间需要认真协调，以监测HIV感染者的移植后护理问题。局部区域疗法在肝细胞癌分期降低患者中的作用正在扩大。

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