在活体捐赠者肝移植后确定的小尺寸综合征的管理:医疗,放射和手术干预:来自ILTS-iLDLT-LTSI共识会议的指南
Varvara A Kirchner1, Sadhana Shankar2, David W Victor3
1Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA.
Transplantation
|September 26, 2023
概括
肝移植后的小规模综合征 (SFSS) 可能导致移植失败. 早期的医疗和干预性放射/手术治疗旨在改善移植功能,但在严重的情况下可能需要再移植.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植手术 移植手术
- 胃肠病学 胃肠病学
背景情况:
- 规模较小的综合征 (SFSS) 是活体供体肝移植 (LDLT) 的严重并发症.
- 它可能导致移植功能不佳,移植损失,并影响移植决策.
- 门外高 perfusion 和高动态支柱体循环是SFSS发展的关键因素.
研究的目的:
- 概述LDLT中SFSS的管理策略.
- 讨论医学,干预性放射学 (IR) 和外科手术方法.
- 确定考虑再移植的标准.
主要方法:
- 审查当前的医学文献和临床指导方针.
- 专注于药理疗法来调节门户流.
- 考虑IR/手术干预以减少门口过度输液.
- 对实验室参数的评估,以预测移植损失和需要再移植的情况.
主要成果:
- 支持性护理的医疗管理旨在促进移植再生.
- 对于耐火性病例或即将出现的功能障碍,IR和/或外科干预是适用的.
- 移植损失的风险随着特定的术后 bilirubin 和 INR 水平显著增加.
结论:
- SFSS管理需要逐步的方法,从保守的措施开始.
- 及时干预IR/外科手术程序可以改善结果.
- 在基于临床和实验室指标的严重或耐火SFSS病例中,重新移植是一个关键考虑因素.
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