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1、Long-TermManagementoftheSuccessfulAdultLiverTransplant(2012PracticeGuideline)感染內(nèi)科科內(nèi)業(yè)務(wù)學習陳洪濤2016-03-17Background------中國肝移植現(xiàn)狀Background------中國肝移植現(xiàn)狀Background------中國肝移植現(xiàn)狀Background------中國肝移植現(xiàn)狀Background------中國肝移植現(xiàn)狀Background------中國肝移植現(xiàn)狀Background------中國肝移植現(xiàn)狀Background------中國肝移植現(xiàn)狀Background---
2、---中國肝移植現(xiàn)狀Survival>85%,4years>75%,5yearsRecurrence8%,4yearsBackground------中國肝移植現(xiàn)狀杭州標準Background------美國肝移植現(xiàn)狀Background------美國肝移植現(xiàn)狀Characteristicsof adultlivertransplantrecipients,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
