KARACİĞER RE-TRANSPLANTASYONU TEK MERKEZ DENEYİMİ: ENDİKASYONLAR-ZAMANLAMA VE KOMPLİKASYONLAR

Year 2024, , 32 - 36, 29.01.2024

Cihan Karataş , Altan Alim , Akın Akbulut , Barış Demir , Bahadır Hakan Oğuz , Turan Kanmaz

https://doi.org/10.26650/IUITFD.1296319

Abstract

Amaç: Karaciğer transplantasyonu için kullanılan greftin çeşitli nedenlerle fonksiyon kaybı re-transplantasyonu gerektirmektedir. Bu çalışmada merkezimizde gerçekleştirilen tüm karaciğer re-transplantasyon olguları değerlendirilmiştir.
Gereç ve Yöntem: Kliniğimizde erken ve geç dönem olmak üzere karaciğer re-transplantasyonu yapılan tüm hastalar çalışmaya dahil edildi. Demografik bilgiler, ameliyatla ilgili detaylar ve komplikasyonlar retrospektif olarak değerlendirilmiştir.
Bulgular: 2018'den 2023'e kadar kurumumuzda 228 alıcıya 236 karaciğer nakli gerçekleştirildi. Bu hastalardan 10'u dış merkezlerden olmak üzere toplam 18 hastaya re-transplantasyon yapılmıştır. Bu hastaların 12'si erkek, 6'sı kadın olup, yaş ortalaması pediatrik hastalarda 6,7 (±4,8), erişkin hastalarda ise 49 (±14,32) idi; çocuk hastaların ortalama ağırlığı 19,76 kg (±8,86), yetişkin hastaların ortalama ağırlığı 70,48 kg (±11,83); çocuk hastaların ortalama vücut kitle indeksi 17,41 kg/m² (±2,84), yetişkin hastaların ise 22,33 kg/m² (±2,65) olduğu belirlendi. Bu hastaların altısına erken retransplantasyon (7,6±5,4 gün), 12'sine geç retransplantasyon (7,6±5,3 yıl) uygulandı. Re-transplantasyon etiyolojisi açısından erken dönemde primer non-fonksiyon ön plana çıkarken, geç dönemde sekonder biliyer siroz, hastalık nüksü ve kronik rejeksiyon saptandı. Perioperatif dönemde yedi alıcı (%39) öldü ve bu hasta grubunda 1 yıllık sağkalım %61 olarak hesaplandı.
Sonuç: Re-transplantasyon yüksek mortalite ve morbidite oranlarına sahiptir. Erken re-transplantasyon, özellikle primer non-fonksiyon vakalarında yüksek ölüm oranlarının üstesinden geliyor gibi görünse de, kadavra organ eksikliği ve canlı donör ihtiyacı önemli sorunlardır.

Keywords

Karaciğer nakli, kronik greft disfonksiyonu, karaciğer re-transplantasyonu

SINGLE CENTER EXPERIENCE OF LIVER RE-TRANSPLANTATION: INDICATIONS-TIMING AND COMPLICATIONS

Abstract

Objective: Function loss, for whatever reason, of the graft used for liver transplantation requires re-transplantation. This study is an evaluation of all re-transplantations performed at our center.
Material and Method: All liver re-transplantation patients whose surgeries had been performed at our clinic, whether at an early or late stage, were included in the study. Demographic in formation, details related to the surgery, and complications were evaluated retrospectively.
Result: From 2018 to 2023, 236 liver transplantations were performed on 228 recipients in our institution. Of these patients, a total of 18 underwent re-transplantation, 10 of whom were from external centers and 8 of whom had had their first liver transplantation performed at our center. Of these patients, 12 were male and 6 were female, with a mean age of 6.7 years (±4.8) for pediatric patients and 49 years (±14.32) for adult patients. The mean weight for pediatric patients was 19.76 kg (±8.86), and for adult patients it was 70.48 kg (±11.83). The mean body mass index for pediatric patients was 17.41 kg/m² (±2.84), and for adult patients it was 22.33 kg/m² (±2.65). Six of these patients underwent early re-transplantation (7.6±5.4 days) and 12 underwent late re-transplantation (7.6±5.3 years). In terms of re-transplantation etiology, primary non-function was prominent for the early period, while secondary biliary cirrhosis, disease recurrence, and chronic rejection were detected for the late period. Seven recipients (39%) died during the perioperative period, and 1-year survival was calculated as 61% in this patient group.
Conclusion: Re-transplantation has high mortality and morbidity rates. Although early re-transplantation seems to overcome high mortality rates, especially in primary non-function cases, organ shortage and the need for living donors are significant problems.

Keywords

Liver transplantation, chronic graft dysfunction, liver re-transplantation

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