Primer Sklerozan Kolanjit İçin Karaciğer Nakli: 20 Yıllık Tek Merkez Deneyimi

Öz

Amaç: Primer sklerozan kolanjit, sıklıkla karaciğer nakline yol açan kronik ve progresif kolestatik bir karaciğer hastalığıdır. Karaciğer nakli ileri evre hastalık için tek kesin tedavi seçeneği olmakla birlikte, nakil sonrası hastalık nüksü uzun dönem sonuçları olumsuz etkileyebilmektedir. Bu çalışmanın amacı, primer sklerozan kolanjit nedeniyle karaciğer nakli uygulanan hastalarda nüks oranlarını ve nakil sonrası klinik sonuçları değerlendirmektir. Gereç ve Yöntem: Bu retrospektif tek merkezli çalışmaya, Aralık 2004 ile Nisan 2025 tarihleri arasında primer sklerozan kolanjit nedeniyle karaciğer nakli yapılan otuz yedi hasta dâhil edilmiştir. Demografik özellikler, klinik bulgular, cerrahi yaklaşımlar, medikal tedaviler, komplikasyonlar, nüks paternleri ve sağkalım sonuçları tanımlayıcı istatistiksel yöntemler kullanılarak değerlendirilmiştir. Bulgular: Çalışma kohortu, nakil sırasında ortalama yaşı 41,9 yıl olan on altı erkek ve yirmi bir kadından oluşmaktaydı. Ortalama hastalık süresi 6,1 yıl, ortalama Model for End-Stage Liver Disease skoru ise 18,4 olarak saptandı. Hastaların yüzde 43’ünde inflamatuvar bağırsak hastalığı mevcuttu ve tümü ülseratif kolit tanısı almıştı. Otuz altı hastaya canlı vericili, bir hastaya ise kadavra vericili karaciğer nakli uygulandı. Eksplante edilen karaciğerlerin ikisinde insidental kolanjiyokarsinom saptandı. İzlem süresince dokuz hastada ortalama 45,6 ayda hastalık nüksü gelişti ve iki hasta yeniden nakil gerektirdi. Beş yıllık mortalite yüzde 13,5 olup ölümlerin üçü hastalık nüksü ve ilişkili komplikasyonlara bağlıydı. Sonuç: Primer sklerozan kolanjitli hastalarda karaciğer nakli uzun dönem sağkalım açısından etkili bir tedavi seçeneği sunmakla birlikte hastalık nüksü önemli bir sorun olmaya devam etmektedir. Yapılandırılmış uzun dönem izlem, optimize edilmiş medikal tedavi ve multidisipliner yaklaşım nakil sonrası sonuçların iyileştirilmesi için gereklidir.

Anahtar Kelimeler

• karaciğer nakli
• kolestaz
• primer sklerozan kolanjit

Destekleyen Kurum

Bu çalışma için herhangi bir destekleyici kurum veya finansal destek bulunmamaktadır

Etik Beyan

Çalışma, İstanbul Demiroğlu Bilim Üniversitesi Tıp Fakültesi Yerel Etik Kurulu tarafından onaylanmıştır (Onay No: 51016662/44696, Tarih: 29.01.2025).

Liver Transplantation for Primary Sclerosing Cholangitis: A 20-Year Single-Center Experience

Öz

Objective: Primary sclerosing cholangitis is a chronic, progressive cholestatic liver disease that frequently leads to liver transplantation. Although liver transplantation remains the only definitive treatment for advanced disease, post-transplant recurrence may adversely influence long-term outcomes. This study aimed to evaluate recurrence rates and clinical outcomes after liver transplantation in patients with primary sclerosing cholangitis. Matherial and Methods: This retrospective single-center study included thirty-seven patients who underwent liver transplantation between December 2004 and April 2025 due to primary sclerosing cholangitis. Demographic characteristics, clinical findings, surgical approaches, medical treatments, complications, recurrence patterns, and survival outcomes were evaluated using descriptive statistical methods. Results: The cohort consisted of sixteen males and twenty-one females with a mean age of 41.9 years at the time of transplantation. The mean disease duration was 6.1 years and the mean Model for End-Stage Liver Disease score was 18.4. Inflammatory bowel disease was present in 43 percent of patients, all diagnosed with ulcerative colitis. Living donor liver transplantation was performed in thirty-six patients, while one patient received a deceased donor graft. Incidental cholangiocarcinoma was identified in two explanted livers. During follow-up, disease recurrence developed in nine patients at a mean of 45.6 months, and two patients required re-transplantation. Five-year mortality was 13.5 percent, with three deaths associated with recurrence and related complications. Conclusion: Liver transplantation provides favorable long-term survival in patients with primary sclerosing cholangitis; however, recurrence remains a significant challenge. Structured long-term surveillance, optimized medical management, and multidisciplinary follow-up are essential to improve post-transplant outcomes.

Anahtar Kelimeler

• cholestasis
• liver transplantation
• primary sclerosing cholangitis

Destekleyen Kurum

No supporting institution or financial support was received for this study.

Etik Beyan

The study was approved by the local ethics committee of the İstanbul Demiroğlu Bilim University, School of Medicine (Approval No: 51016662/44696, Date: 29.01.2025).

Kaynakça

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