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在肝移植候选人中使用特里普林素

Nicodemus Ong¹, Florence Wong¹

¹Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Gastroenterology & hepatology

|September 2, 2025

概括

在肝移植候选人中,对肝综合征1型 (HRS-1) 的terlipressin治疗有争议. 虽然它可以降低移植优先级,但响应者显示移植后结果有所改善,这表明治疗是有益的.

科学领域:

肝病学
移植医学
肝脏病学

背景情况:

在等待肝移植 (LT) 的晚期肝硬化患者中,肝硬化综合征1型 (HRS-1) 显著影响存活率.
由于可能降低MELD得分,影响LT优先级,以及缺血性副作用或呼吸衰竭的风险,terlipressin在HRS-1中存在争议.

研究的目的:

在LT等候名单中的患者中审查terlipressin对HRS-1的优缺点.
审查国际战略,以管理在LT等候名单上的terlipressin响应者.

主要方法:

在HRS-1中对terlipressin有效性和安全性的现有文献的综述.
分析不同国家关于对特里普林素反应者的LT等待列表优先级的政策.

主要成果:

治疗terlipressin后患者的存活率有所改善,慢性病减少,替代疗法 (RRT) 的需要减少.
没有HRS-1的类似MELD得分比HRS-1的生存率更有负面影响.
一些国家采用MELD锁定策略,以保持terlipressin响应者的等待列表优先级.

结论:

目前的证据支持在LT等待患者中治疗HRS-1.
国际战略的目标是平衡terlipressin的好处与公平的LT获取,尽管美国正在等待更多数据.

关键词:

急性损伤蛋白质肝脏病综合征炎症的发生特里普林素血管收缩剂

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