肝臟移植之新進展

Recent Advances and Future Prospects in Liver Transplantation

隨著移植手術技術及圍術期照顧的改善，肝臟移植病人的存活機會提高，肝臟移植成為許多晚期肝臟疾病最佳的治療方法。利用體外循環，提升心跳停止或有脂肪浸潤的捐贈肝使用率，可改善移植肝缺乏的問題；以準確的預測標記作為移植病人的篩選標準，可以提高酒精性肝炎病人的存活率，避免脂肪肝相關共病症對移植後存活的影響；肝癌病人在移植前、後接受抗癌治療，能夠讓原本不能接受移植的病人，接受肝臟移植，也可延長肝癌復發病人的存活時間；微創手術運用在捐贈者手術，可以減少手術造成的疼痛和壓力，縮短住院時間，這樣的技術已經開始被利用在接受者手術；利3D列印和人工智慧可以讓移植手術及治療更加精準，讓肝臟移植結果更加令人滿意。

The survival rate of liver transplant patients significantly improved in recent years with the refinement of surgical techniques and perioperative care. Liver transplantation became the best treatment strategy for various end-stage liver diseases. Extracorporeal support system raises the utilization rate of liver grafts from severe steatosis as well as grafts from resuscitation from cardiac arrest, successfully ameliorating the shortage of liver graft supply. Early transplantation and the use of individualized evaluation increases the survival rate of patients with alcoholic liver disease, and further lowers the impact of hepatic steatosis-associated comorbidities on the survival rates following transplantation. Systemic anti-cancer therapy for patients with hepatocellular carcinoma (HCC) before and after liver transplantation not only provides patients who were initially eligible for surgery an opportunity to receive transplantation but also prolongs the survival of patients with HCC recurrence. Minimally invasive surgery has been widely applied in donor hepatectomy, which both reduces perioperative pain/stress and decreases the length of hospitalized days. Finally, the emerging techniques of 3D printing and artificial intelligence provide a more precise therapy for liver transplantation surgery and further optimize the outcome of liver transplantation.