Canlı Vericili Karaciğer Naklinde Retrospektif Donör Hepatektomi Sonuçları- Tek Merkez Deneyimi

Yıl 2021, , 61 - 65, 02.08.2021

Ramazan Dönmez , Oya Andaçoğlu

https://doi.org/10.25000/acem.929684

Cited By: 1

Öz

Amaç: Donör hepatektomi tekniğimizi ve donör seçimimizi tanımlamayı, vaka serimizi gözden geçirmeyi, komplikasyon oranlarımızı ve sonuçlarımızı bildirmeyi amaçladık.
Gereç ve Yöntemler: Yeditepe Üniversite Hastanesi'nde Ekim 2019 - Kasım 2020 tarihleri arasında 41 ardışık donör hepatektomi olgusunu retrospektif olarak inceledik. Komplikasyonlar Clavien-Dindo sınıflamasına göre derecelendirildi. Tüm olgular laparotomi ile yapıldı.
Bulgular: 41 donör olgusunun 38'i (% 92,6) sağ lob, 2'si (% 4,8) sol lob ve 1'i (% 2,4) sol lateral segment donör hepatektomisi idi. Takip süresi 9 ± 2,2 aydı (4-16 ay). Sekiz (% 19,5) komplikasyon vardı ve hepsi minördü (derece 1 veya 2). Derece 3 veya daha yüksek komplikasyon görülmedi. Üç donörde heterozigot Faktör 5 Leiden mutasyonu ve 4 tanesinde heterozigot protrombin mutasyonu vardı. Kalış süresi ortalama 6,4±1,4 gündü (aralık = 5-12). Kontrollü diyet ve egzersiz programı ile 10 donör kilo verdi. Bu hasta alt grubunda bir yara komplikasyonu vardı.
Sonuç: Tek merkezli donör hepatektomi serimizi çok iyi sonuçlarla sunuyoruz. Ayrıca BMI( Vücut Kitle İndeksi) > 30 olan donörler için başarılı kilo vermeyi de tanımlıyoruz. Donör güvenliği, canlı donör karaciğer naklinin en önemli bileşenidir. Donör sonuçları iyi oldukça, LDLT(Canlı Vericili Karaciğer Nakli) dünya çapında yaygınlaşmaya devam edecektir.

Anahtar Kelimeler

Donör komplikasyonu, donör hepatektomi, karaciğer transplantasyonu, kilo kaybı

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

Retrospective Donor Hepatectomy Results in Living Donor Liver Transplant– A Single-Center Experience

Öz

Objectives: We aimed to describe our technique and donor selection for donor hepatectomy, review our case series and report our complication rates and outcomes.
Materials and Methods: We retrospectively reviewed 41 consecutive donor hepatectomy cases between October 2019 and November 2020 at Yeditepe University, Istanbul, Turkey. Complications were graded according to Clavien-Dindo classification. All cases were performed via laparotomy.
Results: Out of 41 donor cases, 38 (92,6%) were right lobe, 2 (4,8%) were left lobe and 1 (2,4%) was left lateral segment donor hepatectomy. Follow up was 9 ±2,2 months (4-16 months). There were 8 (19,5%) complications and all were minor (grade 1 or 2). There were no grade 3 or higher complications. Three (7,3%) of our donors are heterozygous for factor 5 leiden mutation and 4 (9,7%) of our donors had heterozygous prothrombin mutation. Length of stay was average 6.4±1,4 days (range=5-12). Ten donors lost weight with a supervised diet and exercise program. There was one wound complication in this subset of patients.
Conclusions: We present our single center donor hepatectomy series with excellent results. We also describe successful weight loss for donors with Body Mass Index (BMI) >30. Donor safety is the most important component of living donor liver transplantation. As donor results continue to improve, living donor liver transplant (LDLT) will continue expand worldwide.

Anahtar Kelimeler

Donor complication, donor hepatectomy, liver transplantation, weight loss

Proje Numarası

yok

Kaynakça

• 1. Organ Decision Support System, Ministry of Health, Organ Transplant Centers. KY Software. https://organkds.saglik.gov.tr/dss/PUBLIC/ONM_LiverTransplant Center.aspx Updated December, 2019. Accesed February 6, 2021.
• 2. Braun HJ, Ascher NL, Roll GR, Roberts JP. Biliary complications following living donor hepatectomy. Transplant Rev (Orlando). 2016;30:247-52.
• 3. Kim SJ, Na GH, Choi HJ, Yoo YK, Kim DG. Surgical outcome of right liver donors in living donor liver transplantation: single-center experience with 500 cases. J Gastrointest Surg. 2012;16:1160-70.
• 4. Onur A, Akbulut S, Dirican A, Isik B, Yilmaz S. Life-threatening or nearly life-threatening complications in living liver donors. Clin Transplant. 2018;32(6):e13262.
• 5. Yankol Y, Mecit N, Kanmaz T, Kalayoğlu M, Acarlı K. Complications and outcomes of 890 living liver donor hepatectomies at a single center: risks of saving loved one's life. Turk J Surg. 2020;36:192-201.
• 6. Shaji Mathew J, Manikandan K, Santosh Kumar KY, Binoj ST, Balakrishnan D, Gopalakrishnan U, et al. Biliary complications among live donors following live donor liver transplantation. Surgeon. 2018;16:214-19.
• 7. Erdoğan MA, Çağın YF, Atayan Y, Bilgiç Y, Yıldırım O, Çalışkan AR, et al. Endoscopic treatment of biliary complications in donors after living donor liver transplantation in a high volume transplant center. Turk J Gastroenterol. 2020;31:614-19. 8. Takagi K, Umeda Y, Yoshida R, Watanabe N, Kuise T, Yoshida K, et al. Short-term and long-term outcomes in living donors for liver transplantation: Cohort study. Int J Surg. 2020;84:147-53.
• 9. Huang V, Chen CL, Lin YH, Lin TS, Lin CC, Wang SH, et al. Bilateral proficiency over time leads to reduced donor morbidity in living donor hepatectomy. Hepatobiliary Surg Nutr. 2019;8:459-69.
• 10. Goja S, Yadav SK, Saigal S, Soin AS. Right lobe donor hepatectomy: is it safe? A retrospective study. Transpl Int. 2018;31:600-9.
• 11. Hsu HW, Tsang LL, Ou HY, Huang TL, Chen TY, Yu CY, et al. Donor Outcomes After Liver Donation in Adult to Adult Living Donor Liver Transplantation. Transplant Proc. 2018;50:2588-92.
• 12. Chung JH, Ryu JH, Yang KH, Choi BH, Park Y, Lee TB, et al. Efficacy and Safety of Weight Reduction of the Donor in Hepatic Steatosis for Living Donor Liver Transplantation. Ann Transplant. 2020;25:e923211. 13. Moss J, Lapointe-Rudow D, Renz JF, Kinkhabwala M, Dove LM, Gaglio PJ, et al. Select utilization of obese donors in living donor liver transplantation: implications for the donor pool. Am J Transplant. 2005;5:2974-81.
• 14. Oshita A, Tashiro H, Amano H, Kobayashi T, Onoe T, Ide K, et al. Safety and feasibility of diet-treated donors with steatotic livers at the initial consultation for living-donor liver transplantation. Transplantation. 2012;93:1024-30.
• 15. Jin YJ, Kim KM, Hwang S, Lee SG, Ha TY, Song GW, et al. Exercise and diet modification in non-obese non-alcoholic fatty liver disease: analysis of biopsies of living liver donors. J Gastroenterol Hepatol. 2012;27:1341-47.
• 16. Nakamuta M, Morizono S, Soejima Y, Yoshizumi T, Aishima S, Takasugi S, et al. Short-term intensive treatment for donors with hepatic steatosis in living-donor liver transplantation. Transplantation. 2005;80:608-12.
• 17. El-Meteini M, Dabbous H, Sakr M, Ibrahim A, Fawzy I, Bahaa M, et al. Donor rejection before living donor liver transplantation: causes and cost effective analysis in an egyptian transplant center. Hepat Mon. 2014;14:e13703.
• 18. Bustelos R, Ayala R, Martinez J, Martin MA, Toledo T, Grande S, et al. Living donor liver transplantation: usefulness of hemostatic and prothrombotic screening in potential donors. Transplant Proc. 2009;41:3791-95.
• 19. Singh MK, Lubezky N, Facciuto M, Contreras-Saldivar A, Wadhera V, Arvelakis A, et al. Upper midline incision for living donor right hepatectomy. Clin Transplant. 2016;30:1010-15.
• 20. Marubashi S, Nagano H, Wada H, Kobayashi S, Eguchi H, Takeda Y, et al. Donor hepatectomy for living donor liver transplantation: learning steps and surgical outcome. Dig Dis Sci. 2011;56:2482-90.