优化肝移植候选者

Christopher Kasia, Andres Duarte-Rojo
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摘要

本综述旨在强调肝移植评估和管理中的常见和最佳实践,特别是如何以最佳方式使患者成为成功的受体。药物、程序和行为干预措施的种类越来越多,其证据和临床实践的应用也越来越广泛,为肝移植患者做好最佳准备。这包括治疗肝病常见失代偿的工具,如肝性脑病或腹水,以及在普通人群中也会遇到的相关并发症。除了失代偿的管理,术前护理的整体方法,包括术前康复,对于通过运动计划和营养调整来改善肌肉疏松症、虚弱和生活质量也越来越重要。健康的社会决定因素已成为人们日益认识到的阻碍公平获得LT的障碍,并在过去几年中引起了越来越多的关注。肝移植之路是一个以患者为中心的多学科旅程。失代偿期疾病的并发症需要在管理方面做出深思熟虑的决策,并且需要谨慎平衡,以避免产生会影响临床稳定性和候选资格的先天性并发症。在行为调整和生活方式管理方面的进一步投资是治疗过程中必不可少的一部分。
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Optimizing the liver transplant candidate
The purpose of this review is to highlight common and best practices in liver transplant evaluation and management, particularly on how to best optimize a patient to become a successful recipient. There is an increasing armamentarium of pharmacologic, procedural, and behavioral interventions that has grown in body of evidence and use in clinical practice to best prepare patients for liver transplant. This includes tools in the management of common decompensations in liver disease, such as hepatic encephalopathy or ascites, as well as associated medical comorbidities that are also encountered in the general population. Aside from management of decompensations, a holistic approach to pre-operative care, including prehabilitation, is becoming increasingly more important to improve sarcopenia, frailty, and quality of life through an exercise program and nutritional modifications. Social determinants of health have become an increasingly recognized barrier to equitable LT access and have garnered increasing attention in the last several years. The road to liver transplantation is a multi-disciplinary patient-centered journey. The complications of decompensated disease require thoughtful decision making as it pertains to management and is a careful balance to avoid the creation of iatrogenic complications which can impact clinical stability and candidacy. Further investment in the management of behavioral modifications and lifestyle is an essential part of the treatment process.
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