肝移植供体耐碳青霉烯类肺炎克雷伯菌感染防治多中心专家共识  

Multi center expert consensus on prevention and treatment of carbapenem resistant Klebsiella pneumoniae infection in liver transplantation donors

作　　者：孔凌祥 汪守平 徐西 徐岗 吕涛[1] 杨俭[1] 宋九林 伊力亚尔·艾尔肯 何敏[2] 张中伟[2] 黄一鸣 王普森 赵东[3,4] 高伟 郭文治[6] 傅志仁[7] 李明 杨亮 黎利娟 何玉凤[10] 陈森飚 栗光明 吴忠均 吕国悦[13] 易慧敏[10] 钟林[3,4] 杨家印 KONG Lingxiang;WANG Shouping;XU Xi;XU Gang;LÜTao;YANG Jian;SONG Jiulin;YILIYAER Aierken;HE Min;ZHANG Zhongwei;HUANG Yiming;WANG Pusen;ZHAO Dong;GAO Wei;GUO Wenzhi;FU Zhiren;LI Ming;YANG Liang;LI Lijuan;HE Yufeng;CHEN Senbiao;LI Guangming;WU Zhongjun;LÜGuoyue;YI Huimin;ZHONG Lin;YANG Jiayin(Liver Transplant Center,Organ Transplant Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Organ Transplantation ICU,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;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 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;Hepatobiliary and Pancreatic Surgery,General Surgery Department,Chengdu Third People’s Hospital,Chengdu 610041,P.R.China;School of Medcine,Southern University of Science and Technology,Shenzhen,Guangdong 518055,P.R.China;Organ Transplantation ICU,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510000,P.R.China;Organ Transplant Center,You’an Hospital,Capital Medical University,Beijing 100069,P.R.China;Organ Transplant Center,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,P.R.China;Organ Transplant Center,The First Hospital of Jilin University,Changchun 130031,P.R.China)

机构地区：[1]四川大学华西医院器官移植中心,肝移植中心,成都610041 [2]四川大学华西医院ICU,成都610041 [3]深圳市第三人民医院肝脏外科器官移植中心,广东深圳518112 [4]国家感染性疾病临床医学研究中心,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]成都市第三人民医院普外科肝胆胰外科病区,成都610041 [9]南方科技大学医学院,广东深圳518055 [10]中山大学附属第三医院器官移植ICU,广州510000 [11]首都医科大学附属北京佑安医院肝移植中心,北京100069 [12]重庆医科大学附属第一医院器官移植中心,重庆400016 [13]吉林大学第一医院器官移植中心,长春130031

出　　处：《中国普外基础与临床杂志》2025年第2期133-142,共10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)。

摘　　要：肝移植是目前治疗终末期肝病唯一的有效根治手段。近年来伴随着肝脏移植手术与抗排斥药物的进步,移植手术并发症与器官排斥的发生率逐渐降低;相对地,移植相关感染却逐步成为了影响移植受者预后的主要因素。此外,由于重症生命支持技术的进步,供体于重症监护室治疗的时间延长,移植受者术后继发感染尤其是供体来源性感染成为了受者感染最主要的来源之一。肝移植受者感染常由革兰阴性病原体引起,尤其是耐碳青霉烯类肺炎克雷伯菌感染,目前已经成为肝移植受者致死性感染的主要原因。为降低供肝来源性感染风险,需要加强供体筛查与评估,制定标准化检测流程,合理调整移植后抗感染药物和免疫抑制剂的使用策略,并加强受者免疫状态监测。多学科合作与新技术的应用则是未来感染防控的关键。针对耐碳青霉烯类肺炎克雷伯菌所致的供体来源性感染,四川大学华西医院结合国际总结防治经验,组织相关专家制定了《肝移植供体耐碳青霉烯类肺炎克雷伯菌感染防治多中心专家共识》。Liver transplantation is currently the only effective curative treatment for end-stage liver disease.In recent years,with advancements in liver transplantation surgery and anti-rejection drugs,the incidence of surgical complications and organ rejection has gradually decreased.Conversely,transplant-related infections have increasingly become a major factor affecting the prognosis of transplant recipients.Furthermore,due to the progress in critical life support technologies,the time spent in the donor’s intensive care unit(ICU)has been extended,and post-transplant infections originating from the donor,especially donor-derived infection(DDI),have become one of the primary sources of infection for recipients.Studies have shown that infections in liver transplant recipients are often caused by Gramnegative pathogens,particularly carbapenem-resistant Klebsiella pneumoniae(CRKP),which has now become the leading cause of fatal infections in liver transplant recipients.To reduce the risk of donor-derived infections,it is necessary to strengthen donor screening and evaluation,establish standardized testing processes,and adjust the use strategies of posttransplant anti-infective drugs and immunosuppressants.Monitoring the immune status of recipients is also crucial.Multidisciplinary collaboration and the application of new technologies will be key in future infection prevention and control.To promote the prevention and treatment of CRKP-related donor infections,West China Hospital of Sichuan University,in collaboration with international experiences,has organized relevant experts to develop an expert consensus on the prevention and treatment of CRKP-targeted DDI.

关 键 词：供体来源性感染 耐碳青霉烯类肺炎克雷伯菌 肝移植 公民逝世后器官捐献 

分 类 号：R657.3[医药卫生—外科学] R446.5[医药卫生—临床医学]