Récidive de la maladie initiale

D. Samuel (Professeur d'hépatologie), E. Kimmoun
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Abstract

Since rejection has become better controlled, recurrence of the initial disease on the graft is the most important problem after liver transplantation. Recurrence of the initial disease has been established for the B and C hepatitis and the hepatocellular carcinoma. The diagnosis of recurrence of biliary and auto-immune diseases is difficult and depends on a series of arguments. Hepatitis B recurrence is prevented by injection of anti-HBs immunoglobulin and anti viral therapy whereas hepatitis C is more hardly controlled. The period preceding liver transplantation is the moment of choice to limit the risk of recurrence, by treating the hepatitis C and confirming alcohol abstinence. Optimised management of the alcoholic disease allows decreasing its recurrence. The treatment of hepatitis C recurrence after liver transplantation is under evaluation. The ideal immunosuppression to limit recurrences of hepatitis C and biliary and auto-immune diseases is not currently known. In some cases, the only treatment is re-transplantation.

最初疾病的复发
由于排异反应已得到较好的控制,移植后移植物上的初始疾病复发是最重要的问题。乙肝、丙型肝炎和肝细胞癌可复发。胆道和自身免疫性疾病复发的诊断是困难的,取决于一系列的论点。乙型肝炎可通过注射抗乙型肝炎免疫球蛋白和抗病毒治疗预防复发,而丙型肝炎更难控制。肝移植前的一段时间是通过治疗丙型肝炎和确认戒酒来限制复发风险的选择时刻。优化酒精性疾病的管理可以减少其复发。肝移植后丙型肝炎复发的治疗方法正在评估中。限制丙型肝炎、胆道和自身免疫性疾病复发的理想免疫抑制目前尚不清楚。在某些情况下,唯一的治疗方法是再次移植。
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