雪冰

Roger S. Williams  英国伦敦大学  本次港沪国际肝病会议终身成就奖获得者
Hepatology Digest: Do you think HCC is a major indication for living donor transplantation? Why or why not?
《国际肝病》：您认为HCC可以作为活体供肝肝移植的一个主要适应证吗？为什么？
Prof. Williams: Yes, it certainly is in Japan and China because the number of cadaver organs is very limited. So, wherever there is a limitation in cadaver organs, then living donor transplantation is the only possible option for treating those patients.
Williams教授：可以。因为尸肝来源很有限，中国与日本都是这样的。只要尸肝来源有限，活体供肝肝移植就是这些须进行肝移植的肝癌患者唯一的选择。
Hepatology Digest: So do you find there is a certain cultural barrier in trying to get donors, as far as getting people to do that in Asia?
《国际肝病》：您有没有发现由于文化差异导致的亚洲和西方供肝差异？
Prof. Williams: There is a very big difference between Asia and the West. In Japan, cadaver organ donation, even though it was approved by the government a good number of years ago, still gives rise to very few cadaver organs. The donation rate remains low, so living donor transplantation has remained the way forward. In Korea, which probably does the largest number apart from China of living donor liver transplantations, they have virtually no cadaver organs. In China, as you know, with the new government regulations with respect to cadaver organs from prisoners, there is a big swing to living donor liver transplantation. In the west, where cadaver organ donation rates can be high, particularly in Spain, they don’t do living donor transplantation.
Williams教授：亚洲与西方的确存在巨大差异。在日本，虽然政府已经批准尸肝捐献多年，但是尸肝数量仍然很少，所以活体供肝数量在不断增加。韩国可能是除中国以外进行活体供肝肝移植最多的国家，几乎没有尸肝。在中国，由于政府对于死囚器官管理的新规定的限制，肝移植已偏向于活体供肝。但是在西方，尸肝供肝仍占很大比例，尤其是在西班牙，几乎没有活体供肝肝移植。
Hepatology Digest: Would you please introduce to us how to treat recurrence of hepatocellular carcinoma following liver transplantation?
《国际肝病》：请您给我们介绍一下肝移植后肝癌复发的治疗问题？
Prof. Williams: That is difficult, because the chemo-therapeutic agents have not been shown to be effective and they have very high rates of side effects. You can treat some tumor recurrence after transplantation by radio frequency ablation. Probably radio frequency ablation is the best way because they can be followed serially, the tumor recurrence picked up early, and then they can be targeted by radio frequency ablation. Sorafenib, the new agent that is been discussed just now in the symposium, may be effective in those patients but nobody has any data yet on that.
Williams教授：肝移植后肝癌复发治疗很棘手，因为已证明化疗无效且副作用太大。有些复发肿瘤可以用射频消融治疗。对于发现较早的复发肿瘤，射频消融可能是最佳选择，其最大优点在于可以多次进行。另外，索拉非尼作为新的靶向治疗药物对于这类患者应该有效，但是还没有证据支持。
Hepatology Digest: With the advances in stem cells, hepatocyte transplantation is a promising treatment for several liver diseases and could also be used as a bridge to liver transplantation in cases of liver failure. Could you comment on this idea?
《国际肝病》：随着干细胞研究进展，干细胞移植在多种肝病治疗中展示出良好前景，干细胞移植能否作为衰竭患者肝移植的过渡治疗呢？
Prof. Williams: It is a wonderfully attractive idea, but there is really little evidence to support its use at present, because the evidence base of really significant results of the stem cells surviving and having a functional effect is very limited. Experimentally there is more evidence, but in man there is very little evidence as yet. Though one would like to see it as a potential treatment for acute liver failure, there is as yet no evidence. I think it is going to be several years in the future. It is rather like gene therapy; getting genes into the liver. It was very attractive when it was proposed some years ago, but in fact the number of instances where it can be used clinically remains very small.
Williams教授：这个想法是很好的，但是迄今还没有证据支持，目前关于干细胞存活并发挥功能的证据很有限。另外，虽然干细胞在试验中功效显著，但在真正人体试验中效果尚不明显。干细胞移植可能在急性肝衰竭的治疗中有很好的应用前景，但是目前还没有证据支持。我认为肝细胞移植应用于临床可能还需要数年时间，就像基因治疗一样，将基因注入肝脏内，数年前当有人提出时，是非常吸引人的，但是实际应用于临床的病例数非常少。

Hepatology Digest: So perhaps in the future it could be another tool or weapon in the arsenal for treatment?
《国际肝病》：您认为干细胞移植会成为将来肝病治疗的另一个重要武器吗？
Prof. Williams: I think maybe it is another weapon. The experimental evidence that it may lead to resolution of fibrosis may be an end point which is good in itself, but the end point of improving survival in liver failure may not be obtainable.
Williams教授：有这个可能。现在有实验证据表明，它可以改善肝脏的纤维化，但是尚不能提高肝衰竭的生存率。
Hepatology Digest: We know that steatotic livers as donors may cause the failure of transplantation. Would you talk a little bit about this problem?
《国际肝病》：我们知道脂肪肝作为供肝可以导致肝移植失败，您能谈一下您对这个问题的看法吗？
Prof. Williams: This is a very big problem, because cadaver organs for liver transplant increasingly are being found to be steatotic, because the population is becoming more obese in the west; significantly more obese so that people dying of road accidents are likely to have steatotic livers because they are obese whereas that didn蒸 used to be the case. So that means that the number of suitable cadaver organs is going down. It is well shown for living donor transplantation that a considerable number of potential relatives who want to donate organs have to be excluded, because they are overweight and their liver is steatotic. What you can do is put them on a diet and hope over a few months that they become less steatotic, but of course the recipient by that time may be deteriorating. So, it is a major problem with respect to organ donation and transplantation. Steatotic livers do not do well when transplanted.
Williams教授：这个问题很严峻，脂肪变肝脏移植效果的确欠佳。在西方，我们发现越来越多的供体肝脏存在脂肪变，因为人群肥胖发生率在不断提高；越来越多死于车祸的人因为肥胖导致的脂肪肝而不能应用于肝移植。这就意味着尸肝来源减少。对于活体供肝肝移植也是如此，有相当多的等待肝移植患者的亲属希望能捐献肝脏但却因为超重和脂肪肝而不能如愿。对于医生来说，只能让这部分人控制饮食，希望经过几个月的时间，肝脏脂肪变能够有所改善，从而可以作为肝移植供体，但是在这个等待的过程中，患者的病情会持续恶化。所以说，供肝脂肪变是影响肝移植的一个严峻问题，脂肪肝确实不适合做肝移植供体。
Hepatology Digest: Do you find that this problem is increasing in Asia as well? As you mentioned before, cadaver organs are very difficult to obtain, perhaps due to cultural conditions, and if we have living donors with increasing obesity; have you heard of evidence that the problem is increasing here as well?
《国际肝病》：您认为在亚洲供肝包括活体供肝脂肪变的问题也很严重吗？
Prof. Williams: Yes, it certainly is. The figures from China are frightening, because of the very large population of China. I think I saw figures that there are 80 million diabetics in association with obesity, and obesity is increasing due to adoption of the western diet and less exercise than people used to do. Fatty liver disease, whether in relation to transplantation or just in its own right, is an increasing and major problem.
Williams教授：的确是这样的，中国的研究数据非常惊人，相当比例人群存在肝脏脂肪变。我看到的数据是有8千万肥胖相关的糖尿病患者。而且，由于受西方饮食习惯影响和缺乏锻炼，肥胖人群还在增加。脂肪肝，不管是用于肝移植还是就其本身而言，都是日渐严峻的卫生问题。