肝移植受者雷帕霉素靶蛋白抑制剂临床应用中国专家共识(2023版)  

Chinese expert consensus on clinical application of inhibitors of mammalian target of rapamycin in liver transplant recipients(2023 edition)

作　　者：中国器官移植发展基金会器官移植受者健康管理专家委员会 中国医师协会器官移植医师分会 中华医学会器官移植学分会 国家肝脏移植质控中心 霍枫 徐骁[3] 叶啟发[4] 薛武军[5] 季茹 李建辉 张洪涛 庄莉 范晓礼[4] 卢倩 郭志勇[9] 汪国营 孙强[11] Committee of Health Management for Organ Transplant Recipient of China Organ Transplantation Development Foundation;Branch of Organ Transplant Physicians of Chinese Medical Doctor Association;Branch of Organ Transplant of Chinese Medical Association;National Center for Healthcare Quality Management in Liver Transplant;Huo Feng;Xu Xiao;Ye Qifa;Xue Wujun(不详;General Hospital of Southern Theater Command of PLA,Guangzhou 510010;Zhejiang University School of Medcine,Hangzhou 310003,China;Zhongnan Hospital of Wuhan University,Wuhan 430026,China;First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China)

机构地区：[1]不详 [2]中国人民解放军南部战区总医院,广州510010 [3]浙江大学医学院,杭州310003 [4]武汉大学中南医院,武汉430026 [5]西安交通大学第一附属医院,西安710061 [6]树兰(杭州)医院 [7]空军军医大学西京医院 [8]清华大学附属北京清华长庚医院 [9]中山大学附属第一医院 [10]广州医科大学附属第一医院 [11]中山市人民医院

出　　处：《器官移植》2023年第6期765-780,共16页Organ Transplantation

基　　金：中国器官移植发展基金会器官移植受者健康管理专项基金(COTDF-020004)。

摘　　要：肝移植受者的长期存活和生存质量很大程度上取决于术后中长期健康管理和免疫抑制方案。长期服用免疫抑制剂可导致受者出现肾损伤、代谢性疾病和新发恶性肿瘤等严重并发症,甚至增加肝癌肝移植术后肿瘤复发风险。目前肝移植受者常用的免疫抑制方案以钙调磷酸酶抑制剂(CNI)为基础,但是CNI引起的肾脏毒性、神经毒性和促进肿瘤复发等问题极大地影响了受者预后,近年来临床逐渐减少其用量并寻求替代药物。近年来使用以哺乳动物雷帕霉素靶蛋白抑制剂(mTORi)为基础的免疫抑制方案逐渐增多,国内外多部指南均对肝移植受者使用mTORi给出了指导意见。为了更好地为国内肝移植临床医师提供参考,中国器官移植发展基金会组织国内经验丰富的移植专家,结合已发表的国内外指南、共识和研究进展,经广泛征求意见,共同制订本专家共识。The long-term survival and quality of life of liver transplant recipients largely depend on long-term health management and immunosuppression regimen after surgery.Long-term use of immunosuppressants may lead to severe complications,such as kidney injury,metabolic diseases and new malignant tumors,and even increase the risk of liver cancer recurrence after liver transplantation.At present,common immunosuppressive regimens in liver transplant recipients are delivered based on calcineurin inhibitor(CNI).However,renal toxicity,neurotoxicity and increased tumor recurrence caused by CNI have significantly affected clinical prognosis of the recipients.In recent years,the dosage of CNI has been gradually reduced and alternative drugs have been explored.Recently,the use of immunosuppressive regimens based on mammalian target of rapamycin inhibitor(mTORi)has been gradually increased.Multiple domestic and international guidelines have provided guidance on the use of mTORi in liver transplant recipients.China Organ Transplantation Development Foundation organized experienced transplant experts in China,combined with published guidelines,consensus and research progress at home and abroad and solicited extensive opinions to jointly formulate this expert consensus,aiming to provide reference for liver transplant clinicians in China.

关 键 词：肝移植 免疫抑制 雷帕霉素 西罗莫司 依维莫司 肿瘤复发 

分 类 号：R617[医药卫生—外科学] R979.5[医药卫生—临床医学]