日本的肝移植：成就、局限与未来展望

摘要(中文译文)

肝硬化（LC）构成了巨大且不断增长的全球健康负担，通过肝衰竭和肝细胞癌（HCC）导致高死亡率，而肝移植（LT）仍是唯一确定性的救命疗法。尽管技术和围手术期不断取得进展，但由于器官需求与供给之间的失衡，仍存在关键的未满足需求。在日本，肝移植的实践因活体移植占主导地位以及显著的流行病学转变而具有独特特征：随着抗病毒治疗的应用，病毒性肝炎相关肝硬化的负担已下降，而代谢功能障碍相关脂肪性肝炎（MASH）和酒精相关性肝病（ALD）正成为主要适应证。这一范式转变要求优化移植策略，包括通过整合肿瘤生物学和新型生物标志物来改进HCC候选者的选择，以及审慎考虑免疫治疗相关风险。此外，MASH带来了与肥胖、疾病复发以及代谢干预的作用和时机相关的复杂挑战，而ALD则引发了关于早期移植和复发预防的持续临床和伦理问题。未来的进展将取决于通过机器灌注和异种移植等创新来扩大供体池，以及将适应证扩展至选定的非HCC恶性肿瘤并采用先进的外科技术。总体而言，肝移植正朝着精准化、多学科和创新驱动的范式转变。

Abstract

Liver cirrhosis (LC) represents a substantial and growing global health burden, driving high mortality through liver failure and hepatocellular carcinoma (HCC), for which liver transplantation (LT) remains the only definitive and life-saving therapy. Despite continuous technical and perioperative advances, a critical unmet need persists due to the imbalance between organ demand and availability. In Japan, the practice of LT is uniquely shaped by the predominance of living donor transplantation and a marked epidemiological transition: the burden of viral hepatitis-related cirrhosis has declined with antiviral therapies, while metabolic dysfunction-associated steatohepatitis (MASH) and alcohol-associated liver disease (ALD) are emerging as leading indications. This paradigm shift necessitates refinement of transplant strategies, including improved candidate selection for HCC through integration of tumor biology and novel biomarkers and careful consideration of immunotherapy-related risks. Moreover, MASH introduces complex challenges related to obesity, disease recurrence, and the role and timing of metabolic interventions, whereas ALD raises ongoing clinical and ethical questions regarding early transplantation and relapse prevention. Future progress will depend on expanding the donor pool through innovations such as machine perfusion and xenotransplantation as well as expanding indications to selected non-HCC malignancies and adopting advanced surgical technologies. Collectively, LT is transitioning toward a precision-based, multidisciplinary, and innovation-driven paradigm.

如何引用

Bioscience trends 的其他文献

• 肝母细胞瘤诊断和治疗的最新进展