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.
Samuel教授：事实上，肝移植后的存活有所改善。 在过去的30年里，肝移植术后1年的存活率从80%上升到95%。长期预后的改善得益于更好的免疫抑制治疗、更完善的患者管理以及对肝移植适应证更为准确的掌握。
《国际肝病》：如何更好地进行长期免疫抑制治疗？
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.
Samuel教授：我们应该首先尝试减少免疫抑制剂的毒性作用，特别是需要保护肾脏，因为环孢素对肾脏是有毒的。我们还必须减少免疫抑制剂的心血管并发症。 我认为我们必须调节免疫抑制剂以改善长期生存。
《国际肝病》：儿童肝移植受者术后的长期结局怎样，是慢慢耐受还是器官逐渐肝纤维化，有什么好的改善方法吗
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.
Samuel教授：小儿肝移植能取得很好的效果。儿童肝移植的关键点在于，当给儿童进行肝移植时，我们希望这个移植器官能够伴随他们长期生存。这意味着40~50年的生存期。因此，为了提高生存，减少免疫抑制剂的毒性作用是非常重要的。儿童肝移植还有一个困难时期是在青少年期。青春期时免疫抑制治疗有失败的风险，因此在这一时期我们必须调整免疫治疗，谨慎对待。的确，儿童移植的长期生存是一个非常重要的目标。
《国际肝病》：目前已有多种免疫治疗药物治疗肝癌的临床试验开展，还有药物获得了批准，您对免疫治疗的安全性有何看法？
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.
Samuel教授：免疫治疗是抗癌治疗历程上一场真正的革命，特别是针对黑色素瘤和肺癌。 对于肝细胞癌，免疫治疗主要还处于试验阶段，尚未批准用于HCC。 我认为这是一个有趣的选择，但当然我们必须谨慎，因为存在乙型肝炎或丙型肝炎再激活的风险。 一些肝硬化患者还存在肝衰竭的风险。 但我想，免疫治疗是非常值得探索的HCC治疗方法，仍需进一步研究。