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2026年欧洲肝病学会年会（EASL 2026）于2025年5月27日在西班牙•巴塞罗那正式开幕。作为全球肝病学领域的学术盛会，本届大会汇聚国际顶尖专家学者，共同探讨肝病学、胃肠病学、移植外科及传染病学等领域的最新研究进展与临床实践突破。
大会设置前沿学术报告、高互动性研讨会及专题论坛，为与会者提供深度交流与专业提升的高端平台。为及时传递大会精华内容，肝胆相照平台将全程跟踪报道，本篇精选肝硬化领域热点研究进行整理，以传递大会的最新动态和精彩看点。
研究一 OS-046
TIPS术后实现肝硬化再代偿是可行的，并与极佳生存率相关：EUROTIPS-德国肝硬化研究组多中心研究
Post-TIPS recompensation is achievable and associated with excellent survival: EUROTIPS-german cirrhosis study group multicenter study
Authors：
Michael Praktiknjo¹, Wagner Enrique Ramírez², Markus Kimmann¹, Anna Baiges², Kymentie Ferdinande³, Lukas Hartl⁴, Sheila González-Padilla⁵, Dario Saltini⁶, Alvaro Giráldez-Gallego⁷, Marika Rudler⁸, Jesus Donate⁹, Wim Laleman¹⁰, Dhiraj Tripathi¹¹, Laure Elkrief¹², Martin Sebastian McCoy¹, Marlene Reincke¹³, Amos Zeller¹⁴, Maike Rebecca Pollmanns¹⁵, Christian Jansen¹⁶, Eirini Claas¹⁷, Julian Pohl¹⁸, Sonia Torres², Alberto Zanetto³, Marlene Hintersteininger⁴, Jose Sanchez-Serrano⁵, Lukas Sturm¹³, Georgios Konstantis¹⁴, Karsten Große¹⁵, Carsten Meyer¹⁹, Tony Bruns¹⁵, Moritz Passenberg¹⁴, Michael Schultheiß¹³, Paloma Lluch-García⁵, Mattias Mandorfer⁴, Giulio Barbiero²⁰, Andreea Fodor², Cornelius Engelmann¹⁸, Tobias Weismüller¹⁷, Johannes Chang¹⁶, Theresa Hildegard Wirtz¹⁵, Jassin Rashidi-Alavijeh¹⁴, Dominik Bettinger¹³, Frank Erhard Uschner¹, Luis Téllez⁹, Dominique Thabut⁸, Filippo Schepis⁶, María Pilar Ballester⁵, Thomas Reiberger⁴, Marco Senzolo³, Jonel Trebicka¹, Juan Carlos García-Pagán², Zeyu Wang¹, Virginia Hernández-Gea²
▼ 背景与目的
Baveno VII 对失代偿期肝硬化“再代偿（recompensation）”的定义中排除了接受 TIPS（经颈静脉肝内门体分流术）治疗的患者。然而，对于病因获得控制或治愈的患者，即使接受了 TIPS，也可能在术后实现再代偿，但其发生率及对生存的影响目前尚不明确。本研究旨在探讨接受 TIPS 治疗的失代偿期肝硬化患者中“再代偿”这一概念。
The Baveno VII definition of recompensation of decompensated cirrhosis excluded patients with TIPS. However, patients achieving etiologic control/cure may still recompensate with/after TIPS, but the incidence of recompensation and its impact on survival is unknown. This study investigates the concept of recompensation in decompensated patients treated with TIPS.
▼ 方法
本研究为回顾性多中心研究，纳入来自 EuroTIPS 联盟的前瞻性 TIPS 患者（推导队列，8个中心）以及来自国家真实世界队列的回顾性患者（验证队列，7个中心）。再代偿定义依据 Baveno VII 标准（但不排除 TIPS 患者），包括：（i）病因得到控制；（ii）停用利尿剂及乳果糖/利福昔明后，失代偿事件持续缓解至少12个月；（iii）肝功能改善至 Child–Pugh A 级。主要终点为达到再代偿状态。次要终点为1年、3年及5年无移植生存率。
This retrospective multicenter study included prospective TIPS patients from the EuroTIPS consortium (derivation cohort, 8 centers) and retrospective patients from a national real-life cohort (validation cohort, 7 centers). Recompensation was defined according to Baveno VII criteria (except exclusion of TIPS): (i) control of etiology, (ii) resolution of decompensating events off diuretics and laxatives/rifaximin for 12 months, and (iii) improvement of liver function to Child–Pugh A. Primary outcome was achievement of recompensation. Secondary outcomes were 1-, 3- and 5-year transplant-free survival.
▼ 结果
共纳入 1106 例病因可控的患者，其中酒精相关肝病 819 例（74%）、病毒性肝病 121 例（11%）、自身免疫性/PBC 166 例（15%）。推导队列共纳入 242 例患者（男性占82%），中位年龄57岁，中位 MELD 评分为11，中位随访时间为3.2年。在 TIPS 置入时，202例患者（83.3%）病因已得到控制。其中，27例（13.4%）在 TIPS 后中位1.1年达到再代偿状态，其1年、3年及5年生存率分别为100%、96%和77%；而未达到再代偿的患者对应生存率分别为77%、56%和40%（p = 0.001）。
验证队列共纳入864例患者，其中551例（63.8%）基线时病因已得到控制。在这些患者中，88例（15.9%）于 TIPS 后中位1.4年达到再代偿状态，其1年、3年及5年生存率分别为100%、90%和87%；未再代偿患者对应生存率分别为82%、68%和53%（p = 0.001）。在两个队列中，较低的 MELD 评分（sHR 0.82，95% CI 0.69–0.96）以及酒精性病因（sHR 0.28，95% CI 0.11–0.69）均与实现再代偿独立相关。
In total, 1106 patients with controllable etiology (alcohol: n = 819, 74%; viral: n = 121, 11%; autoimmune/PBC: n = 166, 15%) were included. The derivation cohort included 242 patients (82% male), median age of 57 years and MELD score of 11. Median follow-up was 3.2 years. Etiology was controlled in 202 patients (83.3%) at TIPS implantation. Of those, 27 (13.4%) achieved recompensation status at a median of 1.1 years after TIPS with 1-, 3-, and 5-year survival rates of 100%, 96%, and 77%, respectively, compared to 77%, 56%, and 40% in non-recompensated patients (p = 0.001).
The validation cohort included 864 patients, among whom 551 (63.8%) had controlled etiology at baseline. Of these, 88 (15.9%) achieved recompensation at a median of 1.4 years after TIPS, with 1-, 3-, and 5-year survival rates of 100%, 90%, and 87%, respectively, compared with 82%, 68%, and 53% in non-recompensated patients (p = 0.001).
Lower MELD score (sHR 0.82, 0.69–0.96) and alcohol-related etiology (sHR 0.28, 0.11–0.69) were independently associated with recompensation in both cohorts.
▼ 结论
本研究结果支持：TIPS术后实现肝硬化再代偿是可实现的。达到再代偿状态的患者具有极佳的无移植生存率。这些发现提示，在未来对当前“再代偿”定义进行修订时，TIPS术后再代偿的概念可能值得被纳入考虑。
Our data support the concept that recompensation after TIPS is indeed achievable. Patients with recompensation after TIPS show excellent transplant-free survival. These findings suggest that the role of post-TIPS recompensation may merit consideration in future refinements of current definitions.
研究二 OS-083-YI
基于循证证据建立门窦性血管疾病（PSVD）诊断的主要及次要组织学标准
Evidence-based definition of major and minor histological criteria for the diagnosis of porto-sinusoidal vascular disease
Authors：
Alexandre Sayadi¹, Christine Sempoux², Annette Gouw³, Alberto Quaglia⁴, Alba Díaz⁵, Dina G. Tiniakos⁶, Maria Guido⁷, Prodromos Hytiroglou⁸, Miguel Albuquerque⁹, Camille Pignolet¹⁰, Matthieu Tihy¹¹, Luiz Antônio Rodrigues de Freitas¹², Kenichi Harada¹³, Romil Saxena¹⁴, Prasenjit Das¹⁵, Sanjay Kakar¹⁶, Puja Sakhuja¹⁷, Venancio Alves¹⁸, Maha Guindi¹⁹, David E Kleiner²⁰, Robert Minnee²¹, Michail Doukas²², Sarwa Darwish Murad²³, Lucile Moga²⁴, Virginia Hernández-Gea²⁵, Pierre-Emmanuel Rautou²⁴, Valérie Paradis¹
▼ 背景与目的
目前，门窦性血管疾病（porto-sinusoidal vascular disease，PSVD）的定义主要依赖于特异性及非特异性组织学病变，而这些标准大多基于专家意见。本研究旨在建立基于循证证据的 PSVD 组织学诊断标准。
Definition of porto-sinusoidal vascular disease (PSVD) currently relies on specific and non-specific histological lesions, based on expert opinion. The aim of this study was to establish evidence-based histological criteria for diagnosing PSVD.
▼ 方法
本研究采用四步策略：
（1）通过对10例正常手术切除肝组织进行形态计量学分析，测量血管结构的面积、轴径及数量，从而定义正常肝脏血管结构。
（2）基于文献资料及步骤（1）的结果，对 PSVD 的基本组织学病变进行定义，并评估9名欧洲病理学家之间的一致性。通过分析58例肝穿刺活检标本（42例 PSVD 患者及16例正常肝组织），采用组内相关系数（ICC）及 Fleiss’ kappa 值评估阅片一致性。
（3）确定与 PSVD 诊断相关的组织学病变：进一步分析另一队列中的218例肝活检标本，包括88例伴门静脉高压的 PSVD 患者、89例无肝硬化的慢性肝病患者以及41例活体肝供者。排除了存在肝静脉流出道梗阻的患者。主要组织学标准定义为：PSVD 诊断中特异度 >95% 且敏感度 >10%；次要组织学标准定义为：特异度为80%–95% 且敏感度 >10%。
（4）由来自美国、巴西、印度和日本的9名独立病理学家对上述主要及次要标准进行外部验证。
We used a four-step strategy:
(1) Definition of normal liver vasculature by morphometric analysis of 10 normal surgical liver samples measuring area, axis, and number of vascular structures.
(2) Definition of elementary histological lesions of PSVD based on literature data and results of step 1, and their reproducibility between 9 European pathologists. Inter-reader reproducibility was established by analyzing 58 liver biopsies (42 PSVD patients and 16 normal liver biopsies), using intra-class correlation (ICC) and Fleiss’ kappa.
(3) Identification of histological lesions associated with PSVD diagnosis: review of another cohort of 218 liver biopsies from 88 patients with PSVD and portal hypertension, 89 patients with chronic liver disease without cirrhosis, and 41 living liver donors. Patients with venous outflow obstruction were excluded. Major histological criteria were defined as having a specificity >95% and a sensitivity >10% for PSVD. Minor histological criteria were defined as having a specificity between 80% and 95% and a sensitivity >10% for PSVD.
(4) External validation of these major and minor criteria was done by 9 independent pathologists from the USA, Brazil, India, and Japan.
▼ 结果
步骤（1）和（2）最终形成了包含15种既往与 PSVD 相关的组织学病变图谱，并基于形态计量学及专家共识给出了精确定义。在9名阅片者中，门静脉小静脉狭窄（portal venule stenosis，PVS）的 ICC 值最高（0.51）；而结节性再生性增生（nodular regenerative hyperplasia，NRH）的 Fleiss’ kappa 值为0.26，双人配对 kappa 值范围为0.12–0.67。
研究确定了3项主要组织学标准：≥50%门管区存在 PVS、门静脉肌化（muscularized portal veins）以及 NRH。确定了3项次要标准：25%–50%门管区存在 PVS、再生性改变以及血管结构分布异常。当同一活检中同时存在这3项次要特征时，可达到主要标准的定义（特异度98%，敏感度17%）。
上述结果得到了外部病理学家团队的验证。
Steps (1) and (2) resulted in an atlas of 15 histological lesions previously associated with PSVD, including their precise definitions based on morphometry and expert consensus. Portal venule stenosis (PVS) had the highest ICC across the 9 raters (0.51), while nodular regenerative hyperplasia (NRH) had a Fleiss’ kappa of 0.26, with pairwise kappa ranging from 0.12 to 0.67.
Three major histological criteria were identified: PVS in ≥50% of portal tracts; muscularized portal veins; and NRH. Three minor criteria were identified: PVS in 25–50% of portal tracts; regenerative changes; and abnormal distribution of vascular structures. Presence of these 3 minor features in the same biopsy reached the definition of a major criterion (specificity 98%, sensitivity 17%).
Results were validated by the external group of pathologists.
▼ 结论
本研究通过明确与 PSVD 相关的主要及次要组织学病变，为该疾病2026年修订版定义提供了重要依据，也标志着 PSVD 诊断标准建立过程中的一个重要转折点。
This study, by identifying major and minor histological lesions associated with PSVD, represents a turning point in the revised 2026 definition of this disease.
研究三 OS-084
难治性急性静脉曲张出血患者行TIPS治疗的无效性（futility）判定标准：EuroTIPS研究
Futility criteria for TIPS placement in patients with refractory acute variceal bleeding: a EuroTIPS study
Authors：
Charlotte Bouzbib¹, Luc Haudebourg², Anna Baiges³, Louis Dalteroche⁴, Laure Elkrief⁴, Charlotte Frappreau⁴, Hélene Larrue⁵, Christophe Bureau⁵, Lucie Cavailles⁵, Dhiraj Tripathi⁶, Faisal Khan⁶, David Patch⁷, Jonel Trebicka⁸, Michael Praktiknjo⁹, Markus Kimmann⁸, Nils Manegold⁸, Josune Cabello Calleja⁸, Filippo Schepis¹⁰, Tomas Guasconi¹⁰, Wim Laleman¹¹, Emma Vanderschueren¹¹, Thomas Reiberger¹², Mattias Mandorfer¹², Lukas Hartl¹², Marco Senzolo¹³, Lara Biribin¹³, Johannes Chang¹⁴, Christian Jansen¹⁴, Nina Böhling¹⁴, Jakub Grobelski¹⁴, Fabio Marra¹⁵, Francesco Vizzutti¹⁵, Alexander Zipprich¹⁶, Cristina Ripoll¹⁶, Henrik Karbannek¹⁶, Marlen Hinz¹⁶, Dominik Bettinger¹⁷, Michael Schultheiß¹⁷, Lukas Sturm¹⁷, Pablo Bellot Garcia¹⁸˒¹⁹, Agustín Albillos²⁰, Luis Téllez²⁰, Jesus Donate²⁰, Rebeca Pintado Garrido²¹, Alvaro Giráldez-Gallego²², María Pilar Ballester²³, R. Bart Takkenberg²⁴, Raoel Maan²⁵, Bogdan Procopet²⁶, Oana Nicoara-Farcau²⁶, Silvia Nardelli²⁷, Sarah Raevens²⁸, Lauren Tang²⁹, See Teikchoon²⁹, Navjyot Hansi²⁹, Andres Conthe³⁰, Aurélie Walter³¹, Isabelle Ollivier-Hourmand³¹, Louise Lebedel³¹, Jean-Charles Nault³², Nathalie Ganne-Carrié³², Olivier Sutter³², Jean Marie Peron⁵, Sonia Torres³, Virginia Hernández-Gea³, Manon Allaire¹, Juan Carlos García-Pagán³, Dominique Thabut¹, Marika Rudler¹
▼ 背景与目的
对于肝硬化合并难治性急性静脉曲张出血患者，实施挽救性/救援性经颈静脉肝内门体分流术（TIPS）后，6周死亡率可高达30%–50%。国际指南提出，对于预计6周死亡率超过90%的患者，应慎重考虑是否实施TIPS，包括Child-Pugh评分≥14分，或乳酸≥12 mmol/L和/或MELD评分≥30分的患者，尤其是在无法接受肝移植（LT）的情况下。本研究旨在前瞻性验证上述“无效性（futility）”判定标准。
In patients with cirrhosis and refractory acute variceal bleeding, salvage/rescue transjugular intrahepatic portosystemic shunt (TIPS) placement is associated with a 6-week mortality rate of 30–50%. International guidelines raise the question of placing a TIPS in patients with 6-week mortality >90%, i.e. in patients with a Child-Pugh score ≥14, or in patients with lactate ≥12 mM and/or a MELD score ≥30, especially if they are not candidates for liver transplantation (LT). The aim of this study was to prospectively validate these futility criteria.
▼ 方法
本研究为EuroTIPS注册研究中的一项多中心附属研究，纳入2020年至2024年欧洲19个中心所有连续接受挽救性/救援性TIPS治疗的肝硬化患者。患者于术后1、3、6、9和12个月进行随访，直至死亡或接受肝移植。主要终点为42天死亡率（以肝移植作为竞争风险事件）。研究同时构建了一个TIPS无效性评分系统，并在既往发表的欧洲多中心回顾性队列中进行验证。
This was an ancillary multicenter study within the EuroTIPS registry, which included all consecutive patients with cirrhosis treated with salvage/rescue TIPS between 2020 and 2024 in 19 centers in Europe. Patients were followed up at 1, 3, 6, 9 and 12 months, or until death or LT. The primary endpoint was 42-day mortality (LT as a competing event). We also aimed to develop a futility score for TIPS placement and to validate it in a previously published retrospective multicenter European cohort
▼ 结果
研究共纳入177例患者，其中男性占73.4%，中位年龄54岁；酒精相关性肝硬化占76%；中位Child-Pugh评分为9分，中位MELD评分为16分；23%的患者合并ACLF；接受salvage/rescue TIPS的比例分别为78.5%和21.5%。
42天死亡率为24.3%，salvage TIPS与rescue TIPS之间无显著差异（p = 0.14）。
多因素分析显示，与42天死亡独立相关的因素包括：年龄较大、存在腹水、胆红素升高、INR升高、肌酐升高，以及TIPS实施时需使用血管活性药物。
仅有1例患者Child-Pugh评分≥14分，因此无法验证该标准的预测价值。
在27例MELD评分≥30分和/或乳酸≥12 mmol/L的患者中，42天无移植生存率仍达到37%。
研究基于上述与42天死亡相关的变量建立了新的无效性评分系统。该评分预测42天死亡的AUROC为0.808；在推导队列中，评分≥90分患者的42天死亡率达到100%。
在包含164例患者的验证队列中，共有29例（17.7%）评分≥90分，其42天死亡率为93.1%。
Overall, 177 patients were included (73.4% men, median age 54 years, alcohol-related cirrhosis 76%, Child-Pugh score 9, MELD score 16, ACLF 23%, salvage/rescue TIPS 78.5%/21.5%). Forty-two-day mortality was 24.3%, with no significant difference between salvage and rescue TIPS (p = 0.14).
In multivariate analysis, factors independently associated with 42-day mortality were older age, ascites, higher bilirubin, INR and creatinine, and use of vasopressors at TIPS placement. Only one patient had a Child-Pugh score ≥14, precluding validation of this criterion.
Among the 27 patients with a MELD score ≥30 and/or lactate ≥12 mM, the 42-day transplant-free survival rate was 37%.
A futility score was developed using the previously listed factors associated with 42-day mortality. The AUROC for prediction of 42-day mortality was 0.808, and 42-day mortality was 100% in patients with a score ≥90 in the derivation cohort.
In the validation cohort of 164 patients, 29 patients (17.7%) had a score ≥90, with a 42-day mortality rate of 93.1%.
▼ 结论
在这项前瞻性研究中，接受救援性/挽救性TIPS治疗患者的预后优于既往报道，可能与更严格的患者筛选有关。既往提出的TIPS“无效性”标准未能得到验证。研究建议，对于无法接受肝移植的患者，应结合新的评分系统，对是否实施救援性/挽救性TIPS进行个体化评估。
In this prospective series, rescue/salvage TIPS was associated with a better prognosis than previously reported, possibly due to patient selection. Previously described futility criteria were not validated. A new score should be used to discuss rescue/salvage TIPS on a case-by-case basis in patients who are not candidates for LT.