臨床外科75巻9号

2020年09月発行

特集 変貌する肝移植—適応拡大・ドナー選択・治療戦略の最先端を知る overview

HCCに対する肝移植の新展開—国内外の最近の動向

著者： 嶋村剛¹ 後藤了一² 藤好真人² 渡辺正明³ 川村典生³

所属機関： ¹北海道大学病院臓器移植医療部 ²北海道大学病院消化器外科Ⅰ ³北海道大学大学院医学研究院移植外科学分野

ページ範囲：P.1029 - P.1035

【ポイント】
◆HCCに対する肝移植の適応基準として1996年策定のミラノ基準が現在も世界のgold standardである．
◆基準の拡大とより的確な再発予測を意図し，腫瘍径と個数に腫瘍マーカーなど生物学的悪性度を加味した基準が多数報告されている．
◆わが国の生体肝移植の適応要件はミラノ基準内，脳死肝移植はミラノもしくは5-5-500基準（5 cm・5個・AFP 500 ng/mL以下）内となっている．
◆摘出肝の病理組織所見を加味した再発危険群の予測が試みられ，術後免疫抑制療法の工夫などに役立てられている．

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