昨日是第27届亚太肝病学会年会的第一天,在以“Day to Day Challenges”为主题的肝移植继续教育课程中,来自各国的权威专家围绕“难治患者的活体肝移植”、“肝移植的免疫抑制治疗”、“肝移植后的影像学和病理学”、“肝移植患者的围术期管理”等主题介绍了相关理论和实践知识。《国际肝病》特邀请法国巴黎萨克雷大学、维勒瑞夫肝胆中心Didier Samuel教授讲述肝移植预后与其不可或缺的治疗手段--长期免疫抑制治疗的关系。
《国际肝病》:近日有研究显示,肝移植术后的长期生存在近三十年来改善不多,对此您怎么看。
Dr Samuel: No. In fact, there is some improvement in survival after transplantation. In the last three decades, survival has risen from 80% to 95% after liver transplantation at one year. There is some improvement in survival long-term due to better immunosuppression and better management of patients, as well as better indications for liver transplantation.
Dr Samuel: We should first try to reduce the toxic effects of immunosuppression, and in particular, we need to protect the kidneys, because cyclosporin is toxic for the kidney. We also have to reduce the cardiovascular complications of immunosuppression. I think we have to modulate immune suppression in order to improve long-term survival.
Dr Samuel: Pediatric liver transplantation gives good results. The point is that when children are transplanted, we want them to have a long life with the same graft. This means 40-50 years of survival. So to improve survival, it is important to reduce the toxic effects of immunosuppression. There is also a difficult period in pediatric liver transplantation in adolescence. There is a risk in adolescence of immunosuppression failing and we have to modulate this and be very cautious at this time. Indeed, the long-term survival in pediatric transplantation is a very important objective.
Dr Samuel: Immunotherapy against cancer is a true revolution, particularly against melanoma and lung cancer. For HCC, immunotherapy is still quite experimental. It is not yet approved for HCC. I think it is an interesting option, but of course we have to be cautious because there is a risk of hepatitis B or hepatitis C reactivation. There I also some risk for liver failure in some patients with cirrhosis. But I think this is a new interesting option for HCC that still needs investigation.