肝臟移植治療之免疫抑制劑

Immuonsuppressants in the Treatment of Liver Transplantation

肝臟移植已成為急性或慢性肝病末期患者唯一的治療選項。近年來，此項手術之適應症、禁忌症、手術技術及術後處置也愈趨瞭解及進步。肝臟移植成功率之提昇主要歸功於多種選擇性免疫抑制劑的臨床應用，可因大幅度地減少急性排斥的發生率，進而改善病人術後之短期及長期的預後。但是，尚待解決的部份為此類免疫抑制劑之長期毒性，其可造成心血管、神經性、及腎疾病等併發症。本文將詳述近來應用於肝臟移植之術前及術後之免疫抑制劑的種類及其作用機轉，並提供此項手術術前受贈病人的評估及選擇之相關資訊。

Liver transplantation is the therapeutic option of choice for acute and chronic end-stage liver disease. The indications and contraindications for liver transplantation have become established, as has the operative and post-operative management. Its success can largely be attributed to the generation of selective immunosuppressive agents, which resulted in a dramatic reduction in the incidence of acute rejection and improvements in the short- and long-term outcomes of patients. However, the unresolved limitation of current immunosuppressive agents is long-term toxicity, which results in an increase incidence and severity of cardiovascular, neurological and renal diseases. This review will present currently available immunosuppressive agents used in the perioperative and post-operative period of liver transplantation and provide a clinical approach to evaluation of patients, with emphasis on transplant recipient selection and complications.