肝移植的进展课件.ppt

Cheung ST et al, Transplantation, 2008 Comparison of plasma albumin mRNA levels in healthy individuals, cirrhosis patients with and without HCC Cirrhosis patients Healthy persons HCC patients with transplant P = 0.001 P = 0.043 Liver cancer Implantation in liver graft or extrahepatic organs Apotopsis Circulating Cancer stem cell Circulating cancer cell Hypothesis of HCC recurrence after liver transplantation Detection of HCC cancer stem cell in blood % of CD45-CD90+CD44+ cells Normal persons 0% Cirrhotic patients 0% Liver cancer patients 0.015% (0 – 4.02) Yang ZF et al, Cancer Cell, 2008 University of HK Single CD90- cell Blue: DAPI (nucleus) Single CD90+ cell Blue: DAPI (nucleus) Red: CD90 (cytoplasm and membrane) HCC cancer stem cell Correlation between the number of circulating CD45-CD90+ cells and tumor size Tumor size N No. of circulating CD45-CD90+ cells 5cm 15 0.15 ± 0.27 5cm 21 1.47 ± 2.46* Yang ZF et al, Cancer Cell, 2008 * P = 0.047 Molecular biology screening (tumor, blood) Listed for DDLT/LDLT HCC progression DDLT/LDLT De-listed Disease-free Survived HCC recurrence Died Complications of transplant Died Child B/C HCC patients Radiological screening TOCE, RFA Target therapy Target therapy Future management scheme 肝移植的发展现状 肝移植的历史 肝移植的现状； 肝移植适应症的变迁； 肝癌肝移植 肝移植外科技术的发展； 肝移植的问题和展望； Deceased Donor Classifications Standard criteria donors (SCD) Donor who is neither ECD or DCD Expanded criteria donors (ECD) Donor characteristics with higher relative risk of graft failure* Donation after cardiac death (DCD) Donation from a patient whose heart has irreversibly stopped beating *Definition in evolution (?RR of graft failure 1.7 x expected); potential factors include advanced donor age, steatosis, DCD, split liver, positive hepatitis serologies, some donor causes of death, pressor use, significant down time Expansion of Donor Pool Living donors: donor risk, higher rate of complications, adult to child, adult to adult Older donor: higher PNF, higher recurrence