Selecţia pacienţilor pentru transplantul hepatic: perioada de includere şi factorii de risc

Abstract

Rezumat Perioada de includere a pacientului în lista de aşteptare este foarte importantă, deoarece pacientul în stadiul terminal al bolii trebuie supus intervenţiilor chirurgicale pînă la dezvoltarea unor complicaţii sistemice, incompatibile cu viaţa.Scorul MELD ≥ 15 serveşte ca o recomandare de includere a pacienţilor cu boli hepatice terminale în lista de aşteptare. Toţi candidaţii potenţiali pentru TH (transplant hepatic) necesită examinare complexă înainte de întroducerea în lista de aşteptare. Pacienţii cu vârsta de peste 65 de ani au nevoie de o evaluare complexă multidisciplinară pentru excluderea unor boli concomitente. Înainte de includerea în lista de aşteptare, pacienţii necesită testare pentru infecţii bacteriene, virale şi fungice. Screening-ul pentru neoplasme este obligatoriu pentru candidaţii din lista de aşteptare pentru efectuarea TH. The period of inclusion of the patient in the waiting list is very important because the patient in the terminal stage of the disease must undergo surgery until the development of systemic complications, incompatible with life. The MELD score ≥ 15 serves as a recommendation to include patients with terminal liver disease in the waiting list. All potential candidates for LT (liver transplant) require complex examination before entering the waiting list. Patients aged over 65 need a complex multidisciplinary assessment to exclude concomitant diseases. Before enrolling in the waiting list, patients require testing for bacterial, viral and fungal infections. Screening for neoplasms is mandatory for candidates in the LT waiting list.

Время ТП и период ожидания имеет решающее значение, поскольку пациенты с терминальной стадией поражения печени должны подвергнуться операции прежде, чем у них разовьются угрожающие жизни системные осложнения. Oценка MELD ≥ 15 служит рекомендацией для включения пациентов с терминальной стадией поражения печени в список ожидания. Все потенциальные кандидаты на ТП должны пройти комплексное обследование, прежде чем будут внесены в список ожидания. Пациенты старше 65 лет нуждаются в многопрофильном обследовании для исключения сопутствующих заболеваний. Перед ТП обязательно проводится скрининг на бактериальные, вирусные и грибковые инфекции. Скрининг на новообразования является объязательной частью обследования кандидатов на ТП.

The period of inclusion of the patient in the waiting list is very important because the patient in the terminal stage of the disease must undergo surgery until the development of systemic complications, incompatible with life. The MELD score ≥ 15 serves as a recommendation to include patients with terminal liver disease in the waiting list. All potential candidates for LT (liver transplant) require complex examination before entering the waiting list. Patients aged over 65 need a complex multidisciplinary assessment to exclude concomitant diseases. Before enrolling in the waiting list, patients require testing for bacterial, viral and fungal infections. Screening for neoplasms is mandatory for candidates in the LT waiting list.