多器官联合移植进展__培训课件.ppt

我国临床肝移植存在的主要问题 供体器官严重缺乏问题 适应症严格选择问题 外科技术改进问题 围手术期规范管理问题 展望 我国肝移植实验研究的努力方向 原病复发的防治研究 移植免疫耐受的研究 慢性移植物失功的研究 冷保存与缺血再灌注损伤的研究 拓展供肝来源的相关研究 展望 * Good morning, prof. Wang, prof. Fan, and dear colleagues, It is my great honor here to introduce the present status of liver transplantation in Mainland China. * This figure shows the indication of LT in our center. HBV-related cirrhosis is the main indication in our center. The patients at our center are made up of HBV-related cirrhosis, HCC, severe hepatitis, cholangiocarrinoma, biliary cirrhosis, polycystic liver and kidney, etc. * All recipients performed in stage I were with malignant liver diseases, but the ratio of malignancy to benign decreased gradually.In the stage III, 63.3% recipients were with benign diseases. * We think that tumor size, lymph node status, vascular invasion, lobar distribution and histopathological characteristics are major prognostic factors in recipients with malignant liver diseases. In our centre, 91.3% of HCC were in advanced stage, resulting in 57.7% of recurrence rate in 6 months postoperation.Thus, as to the indication of OLTx for malignancy, we intent to select small HCC (diameter5cm) and cholangiocarcinoma. Advanced HCC should be strictly limited in selection for its high recurrence rate and poor outcome. * Apart from infection and rejection, the common complications of liver transplantation in our center are vascular complications with incidence of 9.6% , and biliary complications of 14.8%. * There were vascular stenosis in 7 cases, including portal vein stenosis in 2 cases, kinking of inferior vena cava and protal vein in 2 cases , hepatic artery stenosis in 2 cases and obstruction of right hepatic vein in 1 case. Thrombosis were found in 4 cases, including portal vein thrombosis in 2 cases and hepatic artery thrombosis in 2 cases. * Apart from infection and rejection, the common complications of liver transplantation in our center are vascular complications with incidence of