免疫疗法和肝移植:未来还是失败?
Parissa Tabrizian1, Allen Yu1, Neha Debnath1
1Liver Transplant and Hepatobiliary Surgery, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy, New York, NY 10029, USA.
The Surgical clinics of North America
|November 12, 2023
概括
新辅助性免疫检查点抑制剂 (ICI) 对扩大肝移植 (LT) 在肝细胞癌 (HCC) 患者的资格有望. 本综述探讨了在LT前和之后的使用,以改善结果.
科学领域:
- 肝胆道手术 肝胆道手术
- 移植瘤学 移植瘤学
- 免疫治疗是一种免疫疗法.
背景情况:
- 肝移植 (LT) 是肝细胞癌 (HCC) 的首要治疗方法.
- 25年前的马扎费罗研究确立了米兰在HCC中LT的标准.
- 由于需求增加和下调策略的成功,扩大对HCC的LT指示至关重要.
研究的目的:
- 审查使用新辅助免疫检查点抑制剂 (ICI) 在HCC的理由.
- 检查目前的经验和ICI治疗的结果在移植前和移植后的HCC.设置.
主要方法:
- 文献综述侧重于用于HCC的新辅助ICI治疗.
- 对评估ICI使用在接受或等待HCC的LT患者的研究分析.
- 审查器官分配政策,包括逐步下调到米兰标准.
主要成果:
- 将HCC降低到米兰标准的下降阶段已成为一种可行的策略,自2017年以来已被纳入美国器官分配中.
- 正在探索新辅助性ICI疗法,以潜在地增加符合LT治疗的HCC患者数量.
- 目前正在收集和分析关于ICI在移植前和移植后HCC环境中的早期数据.
结论:
- 新辅助性ICI疗法代表了对LT的HCC管理的潜在进展.
- 需要进一步的研究,以确定ICI在HCC的LT途径中的最佳作用和安全性.
- 随着HCC治疗的不断变化,LT治疗的界限不断扩大.
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