医、技学院(华盛顿医疗手册培训器官移植)概要1.ppt

Chronic Allograft Dysfunction accounts for the vast majority of late graft losses; mediated by immune and nonimmune factors slowly progressive, insidious; major obstacle to long-term graft survival Pathologic characterization：gradual vascular and ductal obliteration, parenchymal atrophy, and interstitial fibrosis Diagnosis: often difficult and generally requires a biopsy Treatment: if established, no effective therapy; require a second solid organ transplant; aimed at prevention Company Logo Graft Rejection General Principles Diagnosis Manifestations Treatment -----Chronic Allograft Dysfunction Accounts for the vast majority of late graft losses and is the major obstacle to long-term graft survival ?Difficult ?Require a biopsy ?Mediated by immune and nonimmune factors Unique ?No effective therapy ?A second solid organ transplant ?Prevention Complications Infections Renal Disease Malignancy CMV Hepatitis B Hepatitis C EBV Fungus Parasite Complications ●Skin cancer ●Lip Cancer ●Lymphoproliferative Disease ●Bronchogenic Carcinoma ●Kaposi Sarcoma ●Uterine/Cervical Carcinoma ●Renal Cell Carcinoma ●Anogenital Neoplasms Company Logo Complications----Infections Treatment Treatment Diagnosis Polymerase Chain Reaction (PCR) ---- Blood Sample ?Valganciclovir ?450 to 900 mg PO bid ?Ganciclovir ?2.5 to 5.0 mg/kg bid IV adjusted for Renal Function CMV ?Hyperimmune globulin+Ganciclovir ☆ Organ Involvement ?Foscarnet / Cidofovir ☆ Ganciclovir Resistant Complications----Infections Hepatitis Lamivudin Text Ribavirin Interferon Hepatitis B Hepatitis C Oral Fluconazole ●Play a role in the development of posttransplant lymphoproliferative disease ●Immunosuppression ↓ Oral Fluconazole Complications----Infections EBV Fungus Parasite Company Logo Timing and Etiology of Posttransplant Infections Time Period Infectious Complication Etiology 1 month posttransplant Nosocomial pneumonia, wound infection, urinary tract infection, catheter-related sep