编者按：“2016 CSH-AASLD及CSH-EASL肝病联合学术会议”于6月16～18日在北京召开。“2016 CSH-EASL联合会议”中，大会组委特别安排了欧洲学者与中国学者同台报告并交流，包括在欧洲同样常见的自身免疫性肝病、丙肝、肝脏移植等。《国际肝病》有幸邀请到肝移植专题报告讲者、来自比利时鲁汶大学医院的Frederik Nevens博士为我们介绍欧洲的肝移植情况。

 

专家简介

 

Frederik Nevens博士

 

　　比利时鲁汶大学医学教授、比利时鲁汶大学医院肝胆胰疾病科主任，曾担任比利时肝脏与肠道移植委员会（BLIC）主席。其研究和临床兴趣为良性慢性肝脏疾病、肝移植、多囊肝病和肝硬化合并症。

 

　　《国际肝病》：肝移植是治疗终末期肝病有效手段。在欧洲，肝移植患者的主要病因是什么？

 

　　: Liver transplant is an effective means for end-stage liver diseases. What is the primary diseases leading to liver transplantation in Europe?

 

　　Nevens博士：欧洲不是一个国家，欧洲北部与南部肝移植患者的主要病因可能不同。肝移植是治疗终末期肝病有效手段，目前在欧洲肝移植的主要指征是肝细胞癌。肝硬化疾病的病因学多样，例如在法国和比利时，最初的肝脏疾病绝大多数是由酒精性肝脏疾病引起，丙型肝炎也是一个主要原因，脂肪性肝病现在也越来越多。

 

　　Dr. Nevens: Europe is not one country and this may differ in the north of Europe compared to the south. Currently, the main indication for liver transplantation is hepatocellular carcinoma. The etiology of the cirrhotic diseases varies. For example, in France and Belgium, the original liver disease is mostly due to alcoholic liver disease. Hepatitis C is also a major cause and more and more, fatty liver disease.

 

　　《国际肝病》：肝移植等待列表的器官分配优先权过去是基于等待时间和肝病的严重度。目前，MELD评分已经被用于评估等待肝移植患者的器官分配优先权。MELD在应用中存在哪些优势与不足？

 

　　: Priority on the waiting list was based in the past by the waiting time, and severity of liver disease. The model of end-stage liver disease (MELD) score are used for patient priority. What are advantages and disadvantages in the application of MELD?

 

　　Nevens博士：肝移植等待列表的器官分配优先权过去是基于等待时间和肝病的严重度。目前，MELD评分已经被用于评估等待肝移植患者的器官分配优先权。与美国一样，欧洲的大部分肝脏移植中心也正使用MELD（终末期肝病模型）评分系统，以给予在肝移植等待列表上的患者器官分配优先权。MELD是一个基于客观标志物的模型，包括胆红素、凝血功能和肾功能。这意味着存在最高死亡风险的患者将获得器官分配优先权，而在移植名单上的等待时间相对没那么重要。这与其他器官移植患者（如肾脏、心脏和肺脏）相反，例如其他器官移植等待列表上的患者等候时间更重要。这是一个相当公平的系统，使能从移植中最大获益的患者享有器官分配优先权。

 

　　然而，MELD评分系统存在一些的问题，如其最初是用于肝硬化患者，而很多时候移植的原因是多样的，而并非是肝硬化。正如我所说的，如今在欧洲肝移植的主要原因是肝癌，所以我们有一个完善后的系统，称为“adapted MELD”，凭借原发性肝癌（约占全部候选患者的20%）在评分中获得了额外的分数。否则肝癌患者将获得更低的MELD评分。总体而言，基于MELD系统，最需要肝脏的患者保持在肝移植等待列表名单顶端。

 

　　Dr. Nevens: As in the United States, most of the liver units in Europe are using the MELD system to give patients priority on the waiting list. MELD is a score based on objective markers including bilirubin, clotting and kidney function. This means that patients who have the highest risk of dying will receive priority and where waiting time is less important. This is in contrast to other organ transplant patients, such as kidney, heart and lung, for example where waiting time is more important. It is a rather fair system. Patients who will benefit most from transplantation have the priority.

 

　　However, the problem with MELD is that it was developed for patients with cirrhosis and sometimes the reasons for transplantation can be different. As I said, the main reason for transplant in Europe today is liver cancer, so we have a system called adapted MELD whereby patients with primary liver cancer (around 20% of the total patient candidates) receive extra points in the score. Patients with liver cancer would otherwise receive a lower MELD score. This is a fair system. Overall, patients who need it the most go to the top of the list based on the MELD system.