Karaciğer Nakli Tecrübemiz: Bir Yıllık Tek Merkez Çalışması

Abstract

Amaç: Kliniğimizde 2016 yılı içerisinde gerçekleştirilen canlı ve kadavra vericili karaciğer nakli tecrübemizi sunmaktır.Gereç ve Yöntemler: Akdeniz Üniversitesi Tıp Fakültesi Organ Nakli Merkezi’nde 2016 yılı içerisinde canlı ve kadavradan karaciğer nakli yapılan yetişkin ve pediatrik toplam 48 hasta ve vericileri çalışmaya dahil edildi. Demografik veriler, nakil endikasyonları, ameliyata ait teknik bilgiler, safra anastomozu ve vasküler komplikasyonlar, hastanede yatış süresi, takip süresi, greft ve hasta sağkalımı, mortalite nedenleri geriye dönük olarak değerlendirildi.Bulgular: Kırk sekiz 24 erkek, 24 kadın hastanın ortalama ±standart deviasyon yaşı 40,6 ±20,1 idi. En sık nakil endikasyonları Hepatit B Virüsüne bağlı siroz ve kriptojenik sirozdu. Canlı vericiden yapılan nakil sayısı 29 idi. Hastaların ortalama ±SD takip ve hastanede yatış süreleri sırasıyla 5,4 ±3,7 ay ve 23,5 ±20,7 gündü. Hepatik ven anastomozuna ait komplikasyon görülmez iken, bir %2,1 hastada portal ven trombozu, bir %2,1 hastada geç dönemde kısmi hepatik arter trombozuna bağlı akımda azalma ve 8 %16,6 hastada da safra anastomozu komplikasyonu gelişti. Merkezimizde yapılan nakillerde hasta sağkalımı %87,5’dir.Sonuç: Merkezimizde erişkin ve pediatrik hastalara canlı ve kadavradan karaciğer nakilleri başarılı bir şekilde gerçekleştirilmektedir

Keywords

• Karaciğer nakli, Komplikasyon, Sağkalım

Our Liver Transplantation Experience: A One-Year Single Center Study

Abstract

Objective: To present our center’s cadaveric and living donor liver transplantation experience in 2016. Material and Methods: A total of forty-eigtht adult and pediatric patients who had undergone cadaveric and living donor liver transplantation at our organ transplantation center in 2016 were included in our study. The patients’ and donors’ demographics, indications, technical data about operations, postoperative biliary anastomosis and vascular complications, the length of stay in the hospital, follow-up time and outcomes were analyzed retrospectively.Results: Mean ±standard deviation age of patients 24 male, 24 female was 40.6 ±20.1 . The most common indications were HBV-related cirrhosis and cryptogenic cirrhosis. The number of living donor liver transplantations was 29. Mean ±SD follow-up time and length of hospital stay were 5.4 ±3.7 months and 23.5 ±20.7 days, respectively. While no patient had a hepatic vein complication, one 2.1% patient had portal vein thrombosis at the fourth postoperative hour and one 2.1% patient had decreased hepatic arterial flow after the third postoperative month. Complication of bile duct anastomosis was developed in eight patients 16.6% . The rate of patient survival was 87.5%. Conclusion: According to our one-year experience, cadaveric and living donor liver transplantation are performed successfully at our transplantation center

Keywords

• Liver transplantation, Survival, Complication

References

1. Adam R, Karam V, Delvart V, O’Grady J, Mirza D, Klempnauer J, Castaing D, Neuhaus P, Jamieson N, Salizzoni M, Pollard S, Lerut J, Paul A, Garcia-Valdecasas JC, Rodriguez FS, Burroughs A. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol 2012; 57: 675-88.
2. Russo FP, Ferrarese A, Zanetto A. Recent advances in understanding and managing liver transplantation. F1000Res 2016; 5: F1000 Faculty Rev-2895.
3. Usta S, Ates M, Dirican A, Isik B, Yilmaz S. Outcomes of left-lobe donor hepatectomy for living-donor liver transplantation: A single-center experience. Transplant Proc 2013; 45: 961-5.
4. Lo CM, Fan ST, Liu CL, Wei WI, Lo RJ, Lai CL, Chan JK, Ng IO, Fung A, Wong J. Adult-to-adult living donor liver transplantation using extended right lobe grafts. Ann Surg 1997; 226: 261-269; discussion 269-70.
5. Haberal M, Gulay H, Buyukpamukcu N, Telatar H, Bilgin N, Ozdemir A, Arslan G, Karamehmetoglu M, Kayhan B, Bayraktar Y. Liver transplantation in Turkey. Transplant Proc 1991, 23, 2563-5.
6. Lo CM, Fan ST, Liu CL, Yong BH, Wong Y, Lau GK, Lai CL, Ng IO, Wong J. Lessons learned from one hundred right lobe living donor liver transplants. Ann Surg 2004; 240: 151-8.
7. Langnas AN, Marujo W, Stratta RJ, Wood RP, Li SJ, Shaw BW. Hepatic allograft rescue following arterial thrombosis. Role of urgent revascularization. Transplantation 1991; 51: 86-90.
8. Mazzaferro V, Esquivel CO, Makowka L, Belle S, Kahn D, Koneru B, Scantlebury VP, Stieber AC, Todo S, Tzakis AG, et al. Hepatic artery thrombosis after pediatric liver transplantation-a medical or surgical event? Transplantation 1989; 47: 971-7.

9. Legmann P, Costes V, Tudoret L, Girardot C, Hazebroucq V, Uzan E, Fery-Lemonnier E, Bonnin A. Hepatic artery thrombosis after liver transplantation: Diagnosis with spiral CT. AJR Am J Roentgenol 1995; 164: 97-101.
10. Lerut JP, Gordon RD, Iwatsuki S, Starzl TE. Human orthotopic liver transplantation: Surgical aspects in 393 consecutive grafts. Transplant Proc 1988; 20: 603-6.
11. Berrocal T, Parron M, Alvarez-Luque A, Prieto C, Santamaria ML. Pediatric liver transplantation: A pictorial essay of early and late complications. Radiographics 2006; 26: 1187-1209.
12. Kawano Y, Mizuta K, Sanada Y, Urahashi T, Ihara Y, Okada N, Yamada N, Sasanuma H, Sakuma Y, Taniai N, Yoshida H, Kawarasaki H, Yasuda Y, Uchida E. Complementary indicators for diagnosis of hepatic vein stenosis after pediatric living-donor liver transplantation. Transplant Proc 2016; 48: 1156-61.
13. Chok KS, Lo CM. Systematic review and meta-analysis of studies of biliary reconstruction in adult living donor liver transplantation. ANZ J Surg 2016;3: 121-5.
14. Memeo R, Piardi T, Sangiuolo F, Sommacale D, Pessaux P. Management of biliary complications after liver transplantation. World J Hepatol 2015;7:2890-5.
15. Akamatsu N, Sugawara Y, Hashimoto D. Biliary reconstruction, its complications and management of biliary complications after adult liver transplantation: A systematic review of the incidence, risk factors and outcome. Transpl Int 2011; 24: 379-92.
16. Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation: Past, present and preventive strategies. Liver Transpl 2008; 14: 759-69.
17. Zhang S, Zhang M, Xia Q , Zhang JJ. Biliary reconstruction and complications in adult living donor liver transplantation: Systematic review and meta- analysis. Transplant Proc 2014; 46: 208-15.
18. Sanchez-Urdazpal L, Gores GJ, Ward EM, Maus TP, Wahlstrom HE, Moore SB, Wiesner RH, Krom RA. Ischemic-type biliary complications after orthotopic liver transplantation. Hepatology 1992; 16: 49-53.
19. Kasahara M, Egawa H, Takada Y, Oike F, Sakamoto S, Kiuchi T, Yazumi S, Shibata T, Tanaka K. Biliary reconstruction in right lobe living-donor liver transplantation: Comparison of different techniques in 321 recipients. Ann Surg 2006; 243: 559-66.
20. Polese L, Cillo U, Brolese A, Boccagni P, Neri D, Bassi D, Erroi F, Zanus G, D’Amico D, Norberto L. Endoscopic treatment of bile duct complications after orthotopic liver transplantation. Transplant Proc 2007; 39:1942-4.
21. Roumilhac D, Poyet G, Sergent G, Declerck N, Karoui M, Mathurin P, Ernst O, Paris JC, Gambiez L, Pruvot FR. Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation. Liver Transpl 2003; 9: 394-400.
22. Laasch HU, Martin DF. Management of benign biliary strictures. Cardiovascular and Interventional Radiology 2002; 25: 457-66.
23. Cheung HK, Jawan B, Fung ST, Cheng KW, Wang CC, Lee JH. Comparison of hemodynamic changes during orthotopic liver transplantation between total clamping and partial clamping of the inferior vena cava. Transplant Proc 1996; 28: 1721-2.
24. Tzakis A, Todo S, Starzl TE. Orthotopic liver transplantation with preservation of the inferior vena cava. Ann Surg 1989; 210: 649-52.