- 1、本文档共141页,可阅读全部内容。
- 2、原创力文档(book118)网站文档一经付费(服务费),不意味着购买了该文档的版权,仅供个人/单位学习、研究之用,不得用于商业用途,未经授权,严禁复制、发行、汇编、翻译或者网络传播等,侵权必究。
- 3、本站所有内容均由合作方或网友上传,本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺!文档内容仅供研究参考,付费前请自行鉴别。如您付费,意味着您自己接受本站规则且自行承担风险,本站不退款、不进行额外附加服务;查看《如何避免下载的几个坑》。如果您已付费下载过本站文档,您可以点击 这里二次下载。
- 4、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等,请点击“版权申诉”(推荐),也可以打举报电话:400-050-0827(电话支持时间:9:00-18:30)。
查看更多
肝移植的进展;肝移植的发展现状;First orthotopic experimental liver replacement
Transplant bulletin 3:7, 1956;Orthotopic Liver Transplantation; ;;;;;;;肝移植的发展现状;肝移植目前的现状(美国);Survival After LT;Previous: surgery, early graft dysfunction, immediate post-op care, allograft rejection
Current: management of recurrent disease, long-term management of consequences of immunosuppression, eg, renal dysfunction, hypertension, diabetes, obesity, and dyslipidemia
;肝移植的发展现状;Patient Selection Criteria for LT;Liver Disease of Adult RecipientsUNOS Database: 1990-92 vs 1995-96;导致肝移植的原发疾病: 病因学;导致肝移植的原发疾病:相关肿瘤;导致肝移植的原发疾病: 病理学;肝移植的适应症;慢性肝病的手术指征;绝对禁忌症;相对禁忌症;多发性肝囊肿;Allocation of organs: local ? regional ? national
Acute liver failure (status I): first priority
End-stage liver disease
Listing: CTP score ? 7 (5 variables; range: 5-15) or episode of variceal bleed or SBP
Allocation: MELD score (3 variables [INR, total bilirubin, creatinine]; range: 6-40)
HCC
Milan criteria (modified stage 2)
Metabolic and cystic diseases
Petition to Regional Review Board
;Deceased Donor Liver AllocationFebruary 2002 Changes;MELD: Deceased Donor Liver Allocation;患者女性,41岁。
血型:A型。
2007年01月20日,患者因“左下腹痛伴发热4天”在外院诊断为“盆腔炎”行抗炎、对症治疗,01月22日6:00出现精神错乱、语无伦次,7:00出现昏迷、呼之不应伴鼾声,急查
ALT 3512u/L AST 1101u/L TB 153μmm0l/L
HBsAg(+) HBeAb(+) HBcAb(+)
PT 44s INR 3.6
MARS、血浆置换、血液滤过无效 ;Dilemmas in FLF
Rapidly progressive illness
Historically, FLF80% mortality,
20% survived
Intensive medical management often futile
Liver transplantation only “cure”
5.7% OLT for FLF
Shortage of donor organ
Death or complications often intervene;Recurrence of Disease After LT;Diseases That May Recur After LT;Liver transplantation is indicated for appropriately selected patients with decompensated cirrhosis secondary to chronic hepatitis B
Continuous administration of HBIg after liver transplantation
Diminishes reinfection rate
Improves short-term survival compared with that of patients who underwent transplantation for other conditions
However, HB
文档评论(0)