肝移植的进展讲义.ppt

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