Integrating palliative care for liver transplant candidates - "Too well for transplant, too sick for life"
Integrating palliative care for liver transplant candidates - "Too well for transplant, too sick for life"
复制标题
DOI：
10.1001/jama.295.18.2168
复制
发表时间：
2006-05-10
影响因子：
120.7
通讯作者：
Curtis, JR
中科院分区：
文献类型：
--
作者：
Larson, AM;Curtis, JR
在美国，慢性肝脏疾病每年导致超过100万次就诊和超过30万次住院。每年有超过27，000名患者进展为终末期肝病（ESLD），肝功能衰竭或死亡。患有ESLD的患者经历诸如脑病、营养不良、肌肉萎缩、腹水、食管胃静脉曲张出血、自发性细菌性腹膜炎、疲劳和抑郁等并发症。尽管姑息治疗有了显著的改善，但患者的生活质量下降，他们的疾病往往会无情地进展。肝移植是一种有效的治疗选择，可以延长生命并减少许多症状。在目前器官短缺的情况下，高达10%至15%的患者在没有接受器官的情况下死亡。许多患者由于合并症也不是移植的候选人。此外，一些患者接受移植，但死于移植本身的并发症。这样的病人和家庭面临着一个可能治愈但往往致命的疾病的难题。通过一个55岁的妇女的情况下，终身的历史B型肝炎病毒感染谁是等待移植，我们讨论了移植资格的过程和斗争，保持希望治愈面对危及生命的疾病。在所有这些情况下，卫生保健团队必须将姑息治疗的联合收割机要素与生命维持治疗相结合，以最大限度地提高患者的生活质量和数量。
Chronic liver disease results in more than 1 million physician visits and more than 300 000 hospitalizations per year in the United States. More than 27 000 patients annually progress to end-stage liver disease (ESLD), liver failure, or death. Patients with ESLD experience such complications as encephalopathy, malnutrition, muscle wasting, ascites, esophagogastric variceal hemorrhage, spontaneous bacterial peritonitis, fatigue, and depression. Despite significant improvements in palliation, patients' quality of life diminishes and their disease will often inexorably progress. Liver transplantation, a valid treatment option, increases life and reduces many symptoms. With the current shortage of organs, up to 10% to 15% of these patients die without receiving an organ. Many patients also are not candidates for transplantation due to comorbid illness. In addition, some patients receive a transplant but succumb to complications of the transplant itself. Such patients and families face the conundrum of a potentially treatable yet often fatal illness. Through the case of a 55-year-old woman with a life-long history of hepatitis B virus infection who is awaiting transplant, we discuss the transplant eligibility process and the struggle with maintaining hope for a cure in the face a life-threatening illness. In all of these circumstances, the health care team must combine elements of palliative care with life-sustaining therapy to maximize the patient's quality and quantity of life.