Karaciğer Naklinde Middle Hepatik Ven ve Sağ İnferior Hepatik Ven Rekonstrüksiyonunda Polytetrafluoroethylene (PTFE) Greft Kullanımı ve Tıkanmama Oranları: Üç Yıllık Sonuçlarımız

Abstract

Amaç: Canlı Vericili Karaciğer Nakli (CVKN)’nde, modifiye sağ lob takılan hastalarda kullanılan Polytetrafluoroethylene (PTFE) greftlerin zamana göre açık kalma oranları değerlendirilmiştir. Ayrıca açık kalma oranını etkileyen faktörler, erken tıkanma sonrası gelişebilecek sorunlar ve olası greft ilişkili komplikasyonlar incelenmiştir. Materyal ve Metod: 2013-15 yıllarında ameliyat edilen, yaşları 17-74 arasında değişen 168 hasta çalışmaya dahil edildi. Postoperatif takiplerde çekilen Multislice Bilgisayarlı Tomografi (MSBT)’lerin venöz fazları retrospektif olarak incelendi. Hastalara kullanılan PTFE greftlerin tıkanma zamanları ve bu greftlerin drene ettiği segmentteki konjesyon durumu değerlendirildi. Greft ilişkili komplikasyonlar, Greft Alıcı Ağırlık Oranı (GAAO) değerleri ve postoperatif 1 aylık laboratuar bulguları da çalışmaya dahil edildi. Bulgular: Kullanılan PTFE greft açık kalma oranlarının, kriyopresipiye greft çalışmalarıyla kıyaslandığında, daha düşük olduğu görüldü. Greft lokalizasyonuyla açık kalma süreleri arasında anlamlı farklılık bulunmadı. Hastaların boy, kilo, BMI, karaciğer greft ağırlığı (KGA) ve greft alıcı ağırlık oranı (GAAO) ile ilk konjesyon, ilk tıkanma ve tüm venlerin tıkandığı zaman arasında anlamlı korelasyon bulunmadı. GAAO değerleri ile takiplerde tromboze olan greftlerin açık kalma zamanları arasında korelasyon tespit edildi. Kullanılan PTFE greft çapı ile açık kalma süresi arasında anlamlı ilişki bulunmadı. Transplantasyon nedenlerine göre açık kalma durumuna da bakıldı ancak anlamlı bir fark bulunmadı. Sonuç: PTFE greftler erken dönem açık kalma oranlarının yüksek olması nedeniyle, kriyopresipiye greftlerin bulunmadığı şartlarda ancak mevcut komplikasyon potansiyelleri akılda tutularak rekonstrüksiyon amaçlı olarak kullanılabilir.

Keywords

• Karaciğer Nakli
• Middle Hepatik Ven
• Polytetrafluoroethylene Greft

Use of Polytetrafluoroethylene Graft in Reconstruction of Middle Hepatic Vein and Right Inferior Hepatic Vein in Liver Transplantation and Rate of Non-Thrombosis of the Vein Our Three-Year Results

Abstract

Objective: The patency rate of Polytetrafluoroethylene (PTFE) grafts used in patients with modified right lobe implants in Living Donor Liver Transplantation (CVKN) was evaluated over time. In addition, factors affecting patency rate, problems that may develop after early occlusion, and possible graft-related complications were examined. Materials and Methods: 168 patients aged between 17-74 who underwent surgery in 2013-15 were included in the study. Venous phases of Multislice Computed Tomography (MSCT) taken during postoperative follow-ups were analyzed retrospectively. The occlusion times of the PTFE grafts used in the patients and the congestion in the segment drained by these grafts were evaluated. Graft-related complications, Graft Recipient Weight Ratio (GAAO) values, and postoperative 1-month laboratory findings were also included in the study. Results: The patency rate of the PTFE graft used was lower when compared to the cryoprecipitated graft studies. There was no significant difference between graft localization and patency time. There was no significant correlation between the patients' height, weight, BMI, liver graft weight (KGA) and graft recipient weight ratio (GAAO) and initial congestion, first occlusion, and time of all vein occlusion. A correlation was found between GAAO values and patency times of thrombosed grafts during follow-up. There was no significant relationship between the PTFE graft diameter used and the patency time. The patency status according to the reasons for transplantation was also examined, but no significant difference was found. Conclusion: Due to the high early patency rate of PTFE grafts, they can be used for reconstruction purposes only in the absence of cryoprecipitated grafts, but keeping in mind the current complication potential.

Keywords

• Liver Transplantation
• Middle Hepatic Vein
• Polytetrafluoroethylene Graft

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