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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2014, Número 6

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Rev Invest Clin 2014; 66 (6)


Indicaciones de trasplante hepático

Aguirre-Valadez J, Torre A, Vilatobá M, Contreras AG, Sánchez-Cedillo A, Antolinez-Motta J, García-Juárez I

Idioma: Español
Referencias bibliográficas: 86
Paginas: 534-546
Archivo PDF: 183.73 Kb.


RESUMEN

El trasplante hepático (TH) es el tratamiento de elección para pacientes bien seleccionados con enfermedad hepática terminal o falla hepática crónica (FHC), algunos con falla hepática aguda (FHA), carcinoma hepatocelular (CHC) y otras enfermedades que per se no comprometen la función sintética del hígado. En general, el TH ofrece una supervivencia global › 90% a un año. La adecuada selección de los candidatos es de vital importancia dada la escasez en la donación de órganos; la asignación y priorización de órganos a los pacientes en lista de espera de TH se realiza considerando la gravedad de la hepatopatía mediante la escala Model of End Stage Liver Disease (MELD). Las indicaciones de TH en los pacientes con FHC son comunes para todas las etiologías (cualquier tipo de descompensación hepática o la aparición de CHC). El MELD ponderado es una variante que se utiliza en situaciones especiales, como en aquellos pacientes que tengan una hepatopatía estable aunada a complicaciones extrahepáticas graves (por ejemplo, CHC o síndrome hepatopulmonar). Las indicaciones de TH en FHA y falla hepática aguda sobre hepatopatía crónica (FHAHC) no están bien establecidas, existen factores de mal pronóstico que pueden orientar a la necesidad de un trasplante urgente; algunos centros como el Hospital King’s College en Reino Unido han establecido una serie de criterios para la detección de estos pacientes. Actualmente el TH también representa una opción terapéutica para algunas neoplasias primarias del hígado (CHC y colangiocarcinoma), así como en la enfermedad metastásica secundaria a tumores neuroendocrinos (TN), siempre y cuando exista una adecuada selección de pacientes; esto ha brindado posibilidades de supervivencia significativas a largo plazo (› 70% a cinco años). La gran demanda y escasez de órganos han orillado al desarrollo de nuevas estrategias para beneficiar a más pacientes, como la selección de donantes vivos, donantes con criterios extendidos o el trasplante dominó. Esta revisión se enfoca en los datos más relevantes respecto de las diferentes indicaciones de TH.


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