肝移植术后管理课件

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1、Long-TermManagementoftheSuccessfulAdultLiverTransplant(2012PracticeGuideline)感染内科科内业务学习陈洪涛2016-03-17Background------中国肝移植现状Background------中国肝移植现状Background------中国肝移植现状Background------中国肝移植现状Background------中国肝移植现状Background------中国肝移植现状Background------中国肝移植现状Background------中国肝移植现状Background---

2、---中国肝移植现状Survival>85%,4years>75%,5yearsRecurrence8%,4yearsBackground------中国肝移植现状杭州标准Background------美国肝移植现状Background------美国肝移植现状Characteristicsofadultlivertransplantrecipients,2002&2012BackgroundLiverTransplantation(LT)asaTreatmentforEnd-stageLiverDisease/MortalityAfterLT/MorbidityAfterLTCom

3、plicationsofPortalHypertensionAfterLTLiverTests/VascularThrombosisImmunosuppressionLateRejectionPromotingHealthAfterLTBoneHealth.ContentsSystemicDiseaseNutritionandObesityOncologyReproductiveHealthInfectiousDiseaseImmunizationsHepatitis（Viral,PBC/PSC,AIH,ALD,NASH/NAFLD）ContentsRecommendationsandR

4、ationalesMorbidityAfterLTClinicalfeaturesofliverfailureandportalhypertensionresolverapidlyafterLT.Theexceptionissplenomegaly,whichmaypersistforyearsVaricealhemorrhageisveryunusualunlessthepatienthasanoccludedportalvein.Thelateemergenceofhepaticencephalopathysuggeststhedevelopmentofclandestinecirr

5、hosisorapersistentportosystemicshuntLate-onsetascitesorperipheraledemamayindicatestenosisoftheinferiorvenacavaorportalveinanastomosis.RecommendationsandRationalesComplicationsofPortalHypertensionAfterLTRecommendationsandRationalesLIVERTESTSRecommendationsandRationalesVascularThrombosisHepaticarte

6、rythrombosis(HAT)orstenosismaypresentclinicallyafter3months,as:intrahepaticnon-anastomoticstricturesand/orsterileorinfectedfluidcollectionswithintheliver,sometimesreferredtoasbilomasischemiccholangiopathyorbiliarycastsyndrome.RecommendationsandRationalesImmunosuppressionthetargetlevelsafter3month

7、s,wholebloodtroughlevelsTacrolimus---5to10ng/mLCyclosporine---100to150ng/mLSirolimus---5ng/mL.RecommendationsandRationalesLateRejectionCellularrejection(alsoknownasacutecellularrejectionandlate-onsetrejection)Livertest