人类免疫缺陷病毒感染人群肝脏移植围术期管理的多中心专家共识  

Multicenter expert consensus on perioperative management of liver transplantation in patients with human immunodeficiency virus infection

作　　者：赵东[1,2] 唐建信 王普森 阙伟涛 方泰石 黄一鸣 张毅 何云 吴强 张桂梅[2,4] 郑虹 高伟 郭文治[6] 傅志仁[7] 栗光明[8] 汪守平 孔凌祥 杨家印 钟林 ZHAO Dong;TANG Jianxin;WANG Pusen;QUE Weitao;FANG Taishi;HUANG Yiming;ZHANG Yi;HE Yun;WU Qiang;ZHANG Guimei;ZHENG Hong;GAO Wei;GUO Wenzhi;FU Zhiren;LI Guangming;WANG Shouping;KONG Lingxiang;YANG Jiayin;ZHONG Lin(Department of Liver Surgery and Organ Transplantation Center,Shenzhen Third People’s Hospital,Shenzhen,Guangdong 518112,P.R.China;National Clinical Research Center for Infectious Disease,Shenzhen,Guangdong 518112,P.R.China;Department of Infection and Immunology,Shenzhen Third People’s Hospital,Shenzhen,Guangdong 518112,P.R.China;Department of Anesthesiology,Shenzhen Third People’s Hospital,Shenzhen,Guangdong 518112,P.R.China;Department of Liver Transplantation,Organ Transplantation Center,Tianjin First Central Hospital,Tianjin 300190,P.R.China;Department of Hepatobiliary and Pancreatic Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,P.R.China;Department of General Surgery,Ruijin Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200025,P.R.China;Department of Organ Transplantation,You’an Hospital,Capital Medical University,Beijing 100069,P.R.China;Organ Transplant Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]深圳市第三人民医院肝脏外科器官移植中心,广东深圳518112 [2]国家感染性疾病临床医学研究中心,广东深圳518112 [3]深圳市第三人民医院感染与免疫科,广东深圳518112 [4]深圳市第三人民医院手术麻醉科,广东深圳518112 [5]天津市第一中心医院器官移植中心肝移植科,天津300190 [6]郑州大学第一附属医院肝胆胰外科医学部,郑州450052 [7]上海交通大学医学院附属瑞金医院普通外科,上海200025 [8]首都医科大学佑安医院器官移植科,北京100069 [9]四川大学华西医院器官移植中心,成都610041

出　　处：《中国普外基础与临床杂志》2025年第1期9-14,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家重点研发计划项目(项目编号:2022YFC2304705);四大慢病重大专项(项目编号:2023ZD0502400);深圳科研项目(项目编号:JCYJ20220530163011026、G2021008)。

摘　　要：随着抗逆转录病毒治疗的普及,人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染/艾滋病(acquired immunodeficiency syndrome,AIDS)患者的寿命延长,肝脏疾病成为其重要致死因素之一。肝脏移植是终末期肝脏疾病的有效治疗手段,但是HIV/AIDS肝脏移植在国内仍处于发展初期,尚缺乏相关的临床诊疗规范,因此制定了“人类免疫缺陷病毒感染人群肝脏移植围术期管理的多中心专家共识”。本专家共识旨在规范和优化HIV/AIDS肝脏移植的诊疗流程,为国内HIV/AIDS肝脏移植提供了系统指导,推动了该领域的发展和多学科协作。在此共识中,明确了HIV/AIDS肝脏移植患者的手术适应证和禁忌证;强调了术前供者和受者的全面评估,包括感染控制、免疫功能监测以及合并症管理;术中方面,提出了术中操作规范及防范职业暴露的策略;术后方面,强调抗病毒治疗、免疫抑制个体化管理及并发症监测,确保患者顺利恢复和长期生存;远期随访管理重点,包括定期检查肝功能、免疫状态及HIV相关指标,及时调整治疗方案,提高患者生存率和提升患者生活质量。随着临床经验的不断丰富及临床研究的进展,本共识将不断更新。With the widespread adoption of antiretroviral therapy,vast improvements in the life expectancy of individuals infected with human immunodeficiency virus(HIV)/acquired immunodeficiency syndrome(AIDS)were seen,and the liver disease of this population has become a leading cause of mortality.Although liver transplantation is as an effective treatment for end-stage liver disease,it remains in its nascent stage for the patients with HIV/AIDS in China,lacking standardized protocols and substantial clinical experience.Therefore,a“Multicenter expert consensus on perioperative management of liver transplantation in patients with human immunodeficiency virus infection”was formulated.This expert consensus aims to standardize and optimize the diagnosis and treatment process for liver transplantation in HIV-infected patients,providing systematic guidance for this procedure in China and fostering multidisciplinary collaboration and development in the field.This expert consensus clearly delineates the indications and contraindications for liver transplantation in HIV-infected patients,emphasizing comprehensive preoperative evaluations of both donors and recipients.These evaluations include infection control measures,immune function monitoring,and management of comorbidities.In terms of surgical procedures,strategies to prevent occupational exposure and intraoperative guidelines are outlined.Postoperatively,the focus is on antiviral therapy,individualized immunosuppression management,and vigilant monitoring of complications to ensure patient recovery and long-term survival.The long-term follow-up management prioritizes regular assessments of liver function,immune status,and HIV-related indicators to adjust treatment plans and enhance patient survival rates and quality of life.With the continuous enrichment of clinical experience and the progress of clinical research,this consensus will be continuously updated.

关 键 词：人类免疫缺陷病毒 艾滋病 肝脏移植 围术期管理 

分 类 号：R51[医药卫生—内科学]