Long term management of liver transplantation patientsDepartment of hepatobiliary surgery Peking University People's Hospital Li GuangmingSi
Long term management of liver transplantation patients
Department of hepatobiliary surgery Peking University People's Hospital Li Guangming
Since the successful transplantation of liver transplantation in the last century in 60s, after half a century of development and improvement, liver transplantation has made hundreds of thousands of patients with end-stage liver disease. At present, abroad each year to carry out about 8000 cases of liver transplantation, 1 year survival rate reached more than 90%, 5 year survival rate reached more than 70%; the liver transplantation in recent years the development is also very fast, every year about liver transplant 2000-3000 cases, 1 year survival rate reached more than 85%, more than 50% 5 year survival rate. Visible, although the rapid development of liver transplantation, but the patient's long-term survival rate compared with foreign countries there is still a small gap. As one of the center of the country to carry out the first liver transplantation surgery, since the Department of hepatobiliary surgery of Peking University People's Hospital since May 18, 2000 to implement the first liver transplant to June 2008, a total of 8 years to complete a liver transplant in more than and 600 cases, including 20 cases of living donor liver transplantation. The 1 year survival rate of the patients in the people's hospital was up to 90%, and the survival rate was more than 5, which was close to the international advanced level.
In order to ensure the long-term survival of patients with liver transplantation, we believe that the long-term management of patients is the subject of research, while the long-term survival of patients with education is also very important. May 18, 2008, the occasion of the 8 anniversary of the Peking University People's Hospital to carry out liver transplantation on the occasion, we and the Beijing liver transplant patients Association organized a long-term management of liver transplantation patients. Next, the author combined with the contents of this lecture and his own experience in the clinical work of liver transplantation for nearly 10 years, to talk about the long-term management of liver transplantation patients.
In the years of clinical work, the author found that with the passage of time, the patients with hypertension, hyperglycemia, hyperlipidemia and renal function decreased gradually. Some patients need to bear a lot of medical expenses, and the quality of life of patients has been greatly affected, the patient's long-term survival is not guaranteed. Why is there such a phenomenon? I think it can be analyzed from two aspects.
First, the side effects of drugs. We know that liver transplant patients need to take immunosuppressive drugs for life. At present, most of the immunosuppressive strategies in liver transplantation patients are based on the calcineurin inhibitors (CNI, such as cyclosporine, FK506, etc.). CNI drugs play an important role in ensuring the long-term survival of patients with liver transplantation, and more than 10 years of long-term survival after liver transplantation. However, CNI drugs can reduce the occurrence of rejection, and inevitably lead to a series of side effects. Among them, the renal toxicity of CNI drugs, as well as the side effects caused by high blood pressure, high blood sugar, high blood lipids in recent years has received much attention and research.
Second, unhealthy lifestyle. For example, smoking, drinking, staying up late, excessive weight gain, no control over diet and excessive maintenance, etc., will induce the disease. So, for these two reasons, what are we to do?
For drug toxicity, because CNI drug toxicity is dose dependent, that is to say the higher the dose the greater toxicity, so the cause for CNI toxicity of kidney damage and other side effects, appropriate to reduce the dose of the drug is necessary CNI. Some patients may be worried that this will lead to immunosuppression? I think the CNI reduction is necessary, in order to prevent the occurrence of acute rejection, we add some not related side effects of immunosuppressive agents, such as Cellcept (chemical name: mycophenolate mofetil). Cellcept was an inhibitor of immune renal toxicity is very small. I often and patients take a simple example: for example, people only eat vegetables, a dish with each eat a little to eat two dishes, though they can eat, but obviously, eat two dishes for more comprehensive nutrition. After liver transplantation, immunotherapy is a complex process. Many scholars have advocated single drug therapy, which is considered to be convenient and easy to use. However, with the development of liver transplantation, with the increasing number of patients with liver transplantation, the side effects caused by monotherapy are more and more prominent. I try to adjust the dosage for patients 12 were diagnosed as CNI toxicity caused by renal damage, 4 weeks will be reduced to half the original dose of CNI, combined with MMF 1 grams per day, 3 months later, 11 patients were alleviated, and no acute rejection. Visible, as long as the appropriate collocation, eat two dishes better nutrition.
For a healthy lifestyle, the author also combined with years of experience, to the majority of patients with friends some suggestions.
First, quit smoking, alcohol. Has the patient friend to ask, does not have a cup of drink every day? Can, but it is best to wine and other low degree, the liquor is still free of the strike, in addition, it is necessary to control the amount of!
Second, diet should pay attention to. Patients with liver transplantation, with high vitamin, low sugar, low fat, and appropriate quality protein. Eat small meals, with soft digestible, less fiber, less stimulation of soft or semi liquid diet. To strictly limit the intake of sugar: Fruit 150 - 300g/ days, generally no more than 250 g/ days. Diet should be light, do not eat fried, fried food. Limit high cholesterol food intake, such as animal offal, egg yolk, squid and fish. Appropriate calcium: immunosuppressive agents can inhibit the absorption of calcium, long-term use can lead to osteoporosis, joint pain, tetany, can add milk, soup bones, etc.. Do not eat too much, for easy to cause allergic food, such as: shrimp, crab, shellfish shellfish culture, do not eat too much. Patients with high uric acid should not eat too much broth. Eat less salty foods, such as crackers.
Third, reasonable allocation of work, rest and exercise time. Liver transplant patients can live like normal people, work. Just be careful not to overwork, rest on time, while proper exercise, to improve their immunity is very good.
Fourth, the most important point, review on time! This is crucial for long-term survival of patients! Some patients adhere to the review for 1 years, I feel that everything is stable, it slowly gave up the review, and even their own by the experience of unauthorized change medicine, medicine. It is irresponsible for themselves, their families, their donors, and their doctors. The goal of liver transplantation is not only to be successful, but to provide a new life for critically ill patients, and to enable him to live a long and healthy life. Only the regular review, in order to detect the patient's adverse condition, so as to take timely treatment to ensure the long-term survival of patients.
The true success of liver transplantation depends on the long-term survival rate of patients, which is inseparable from the active cooperation between doctors and patients. I hope the majority of patients with friends, especially in patients with long-term friend, be sure to review on time, follow the doctor's advice, to live longer and healthier!