《肝移植术后管理》PPT课件

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Recommendations and Rationales
Late Rejection
• Cellular rejection (also known as acute cellular
rejection and late-onset rejection)
➢ Liver tests nonspecific abnormalities with a rise in
Immunosuppression
the target levels after 3 months, whole blood trough levels Tacrolimus --- 5 to 10 ng/mL Cyclosporine---100 to 150 ng/mL Sirolimus --- 5 ng/ mL.
中国肝移植现状
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Recommendations and Rationales
Morbidity After LT
Fra Baidu bibliotek
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Recommendations and Rationales
Complications of Portal Hypertension After LT
• Clinical features of liver failure and portal hypertension resolve rapidly after LT.
美国肝移植现状
Characteristics of adult liver transplant recipients, 2002 & 2012
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Background
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Contents
1. Liver Transplantation (LT) as a Treatment for Endstage Liver Disease / Mortality After LT / Morbidity After LT
2. Complications of Portal Hypertension After LT
3. Liver Tests / Vascular Thrombosis
4. Immunosuppression
5. Late Rejection
6. Promoting Health After LT
7. Bone Health.
• Late-onset ascites or peripheral edema may indicate stenosis
of the inferior vena cava or po.rtal vein anastomosis.
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Recommendations and Rationales
LIVER TESTS
中国肝移植现状
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中国肝移植现状
Survival >85%, 4years Recurrence 8%, 4years
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>75%, 5years
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中国肝移植现状
杭州标准
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美国肝移植现状
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Contents
8. Systemic Disease 9. Nutrition and Obesity 10. Oncology 11. Reproductive Health 12. Infectious Disease 13. Immunizations 14. Hepatitis（Viral, PBC/PSC, AIH, ALD, NASH/NAFLD ）
serum bilirubin and aminotransferases
➢ Histologically, cellular rejection is characterized by the triad of inflammatory bile duct damage, subendothelial inflammation of the portal, central, or perivenular veins, and a predominantly lymphocytic portal inflammatory infiltrate with neu- trophils and eosinophils in addition
sterile or infected fluid collections within the liver, sometimes referred to as bilomas • ischemic cholangiopathy or • biliary cast syndrome.
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Recommendations and Rationales
• The exception is splenomegaly, which may persist for years
• Variceal hemorrhage is very unusual unless the patient has an occluded portal vein.
• The late emergence of hepatic encephalopathy suggests the development of clandestine cirrhosis or a persistent portosystemic shunt
Long-Term Management of the Successful Adult Liver Transplant
(2012 Practice Guideline)
感染内科科内业务学习 陈洪涛 2016-03-17
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中国肝移植现状
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Recommendations and Rationales
Vascular Thrombosis
Hepatic artery thrombosis (HAT) or stenosis may present clinically after 3 months, as : • intrahepatic non-anastomotic strictures and/or