Öz
Background:
Liver transplantation is the current treatment for end-stage liver failure. In this article, we aimed to present our experience with cadaveric donor liver transplants between 30.07. 2015 and 30.07.2016 in our newly established Organ Transplant Center.
Patients and Method:
The organs were provided from drain deaths declared cadavers in hospitals linked to the coordination system in Isparta and its district. Organ pairings were achieved according to the data of the Ministry of Health. Vena cava anastomoses of orthotopically transplanted livers were performed with the piggy-back method by applying partial clamping. The standard end-to-end anastomoses were performed for portal vein and hepatic artery. Bile duct anastomoses were performed end–to-end over the stent.
Results:
Since the establishment of our organ transplantation center 9 cadaveric donors were acquired to the national system and 7 liver transplantations were performed in our center. Seven patients (5 male, 2 female), mean age 55,3 (45-72) years, cadaveric donor liver transplantation were performed. Patients’ characteristics, diagnosis, operation times, the amount of transfusion, complications and MELD score are summarized in Table 1. Except for one mortality, all patients were discharged without any complication. However, 6 months after operation acute myeloid leukemia was detected in one patient whose treatment continues. A woman who developed the biliary tract stenosis at the post-operative 7th month was treated endoscopically. Post-operative 3. day one patient mortality were observed due to portal vein thrombosis. The histopathology reports of the removed livers were compatible the preoperative diagnosis.
Conclusion:
We consider that the patient selection, careful follow-up, and treatment of the patients are the reasons for the lack of early complication in this newly established transplantation center.
Anahtar Kelimeler
Kaynakça
- 1.Akbulut S, Yilmaz S. Liver transplantation in Turkey: historical review and future perspectives. Transplant Rev (Orlando). 2015;29(3):161-7.
- 2. Petrowsky H1, Busuttil RW. Evolving surgical approaches in liver transplantation. Semin Liver Dis. 2009;29(1):121-33.
- 3. Fukazawa K1, Nishida S, Hibi T, Pretto EA Jr. Crystalloid flush with backward unclamping may decrease post-reperfusion cardiac arrest and improve short-term graft function when compared to portal blood flush with forward unclamping during liver transplantation. Clin Transplant. 2013;27(4):492-502.
- 4. Kaltenborn A, Gwiasda J, Amelung V, Krauth C, Lehner F, Braun F. Comparable outcome of liver transplantation with histidine-tryptophan-ketoglutarate vs. University of Wisconsin preservation solution: a retrospective observational double-center trial. BMC Gastroenterol. 2014;14:169.
- 5. Mejía GA, Olarte-Parra C, Pedraza A, Rivera JB, Benavides CA. Biliary Complications After Liver Transplantation: Incidence, Risk Factors and Impact on Patient and Graft Survival. Transplant Proc. 2016;48(2):665-8.
- 6.Schrem H, Klußmann A, Focken M, Emmanouilidis N, Oldhafer F, Klempnauer J. Post-Operative Hemorrhage After Liver Transplantation: Risk Factors and Long-Term Outcome. Ann Transplant. 2016;21:46-55.
- 7. Aranzana EM, Coppini AZ, Ribeiro MA, Massarollo PC, Szutan LA, Ferreira FG. Model for End-Stage Liver Disease, Model for Liver Transplantation Survival and Donor Risk Index as predictive models of survival after liver transplantation in 1,006 patients. Clinics (Sao Paulo). 2015;70(6):413-8.
- 8. Morell B1, Dufour JF. Liver transplantation - when and for whom it should be performed. Ther Umsch. 2011;68(12):707-13.
- 9. López-Andújar R, Orón EM, Carregnato AF, Suárez FV, Herraiz AM, Rodríguez FS. T-tube or no T-tube in cadaveric orthotopic liver transplantation: the eternal dilemma: results of a prospective and randomized clinical trial. Ann Surg. 2013;258(1):21-9.
Öz
Giriş ve
Amaç:
Karaciğer
nakli son dönem karaciğer yetersizliğinde güncel tedavi olmaya devem etmektedir.
Bu yazıda yeni kurulan Organ Nakli Merkezimizde 30.07. 2015 ile 30. 07. 2016
tarihleri arasında yapılan kadavra donörlü karaciğer nakli sonuçlarını ve
deneyimlerimizi sunmayı amaçladık.
Hastalar ve
Metod:
Organlar Isparta
ve bölgedeki koordinasyon sistemine bağlı hastanelerde ortaya çıkan beyin ölümü
deklare edilmiş kadavralardan sağlandı. Organ eşleşmeleri sağlık bakanlığı
verileri doğrultusunda gerçekleşti. Ortotopik olarak nakledilen karaciğerlerin
vena kava anastomozları parsiyel klempaj uygulanarak piggy-back yöntemiyle ile
yapıldı. Portal ven ve hepatik arter anoztomozları ise standart olarak uç-uca
yapıldı.
Safra anastomozları
stent üzerinden uç-uca yapıldı.
Bulgular:
Organ nakli
merkezinin kurulduğu tarihten bu yana 9 adet kadavra donör ulusal sisteme
kazandırılmış olup, 7 karaciğer nakli ise merkezimizde yapıldı. Yaş ortalaması
55, 3 (45-72) olan 5 erkek,2 kadın toplam 7 olguya kadavra donörlü karaciğer
nakli yapıldı. Olguların özellikleri, ameliyat süreleri, yapılan transfüzyon,
komplikasyonlar ve MELD skorları Tablo 1. de özetlenmiştir.
Bir
mortalite dışında hastalarımızın tümü sorunsuz olarak taburcu edildi. Bir kadın
olguda 7. ayda biliyer darlık gelişti ve
endoskopik olarak tedavi edildi. Bir hastamızda 6. ayda
akut miyeloid lösemi tespit edilmiş olup tedavisi halen devam etmektedir. Bir olgu
post-operoperatif 3. günde portal ven trombozu nedeniyle kaybedildi.
Çıkarılan
karaciğer histopatoloji raporları primer tanıları ile uyumlu bulundu.
Sonuç:
Yeni kurulan
bir organ nakli merkezinde erken dönemde ciddi bir komplikasyon görülmemesinin
nedeni olarak, hasta seçimi, takip ve tedavilerinin dikkatli yapılmasına bağlı
olduğunu düşünmekteyiz.
Anahtar Kelimeler
transplantasyon organ nakli karaciğer nakli transplantation organ transplantation
Kaynakça
- 1.Akbulut S, Yilmaz S. Liver transplantation in Turkey: historical review and future perspectives. Transplant Rev (Orlando). 2015;29(3):161-7.
- 2. Petrowsky H1, Busuttil RW. Evolving surgical approaches in liver transplantation. Semin Liver Dis. 2009;29(1):121-33.
- 3. Fukazawa K1, Nishida S, Hibi T, Pretto EA Jr. Crystalloid flush with backward unclamping may decrease post-reperfusion cardiac arrest and improve short-term graft function when compared to portal blood flush with forward unclamping during liver transplantation. Clin Transplant. 2013;27(4):492-502.
- 4. Kaltenborn A, Gwiasda J, Amelung V, Krauth C, Lehner F, Braun F. Comparable outcome of liver transplantation with histidine-tryptophan-ketoglutarate vs. University of Wisconsin preservation solution: a retrospective observational double-center trial. BMC Gastroenterol. 2014;14:169.
- 5. Mejía GA, Olarte-Parra C, Pedraza A, Rivera JB, Benavides CA. Biliary Complications After Liver Transplantation: Incidence, Risk Factors and Impact on Patient and Graft Survival. Transplant Proc. 2016;48(2):665-8.
- 6.Schrem H, Klußmann A, Focken M, Emmanouilidis N, Oldhafer F, Klempnauer J. Post-Operative Hemorrhage After Liver Transplantation: Risk Factors and Long-Term Outcome. Ann Transplant. 2016;21:46-55.
- 7. Aranzana EM, Coppini AZ, Ribeiro MA, Massarollo PC, Szutan LA, Ferreira FG. Model for End-Stage Liver Disease, Model for Liver Transplantation Survival and Donor Risk Index as predictive models of survival after liver transplantation in 1,006 patients. Clinics (Sao Paulo). 2015;70(6):413-8.
- 8. Morell B1, Dufour JF. Liver transplantation - when and for whom it should be performed. Ther Umsch. 2011;68(12):707-13.
- 9. López-Andújar R, Orón EM, Carregnato AF, Suárez FV, Herraiz AM, Rodríguez FS. T-tube or no T-tube in cadaveric orthotopic liver transplantation: the eternal dilemma: results of a prospective and randomized clinical trial. Ann Surg. 2013;258(1):21-9.
Ayrıntılar
| Konular | Sağlık Kurumları Yönetimi |
|---|---|
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 14 Nisan 2017 |
| Gönderilme Tarihi | 9 Mart 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 8 Sayı: 2 |
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https://doi.org/10.6002/ect.2021.0295
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