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Karaciğer nakli yapılan hastalarda postoperatif erken dönemdeki rejeksiyonların göstergesi olabilecek parametreler

Yıl 2021, Cilt 11, Sayı 4, 440 - 444, 31.07.2021

Öz

Amaç: Karaciğer nakli yapılan hastalardaki postoperatif erken dönemde gelişen akut rejeksiyonların belirlenmesinde enflamatuar parametrelerin önemini araştırmayı amaçladık. Gereç ve Yöntem: 2020 yılında Yeditepe Üniversitesi Hastanesinde yapılan karaciğer nakilleri sonrası erken dönemde rejeksiyon gelişen hastaların, preoperatif, rejeksiyon geliştiğinde ve pulse steroid tedavi sonrası taburculuğundaki hemoglobin, Nötrofil/Lenfosit oranı, AST/Lenfosit oranı, AST/Nötrofil oranı, ALT/Lenfosit oranı, ALT/Nötrofil oranı , CRP/Albumin oranı, Glukoz, tacrolimus ve GRWR (Graft recipient weight ratio) düzeylerine bakıldı. Rejeksiyon gelişmeyen grubun da preoperatif ve taburcu edildiğindeki değerlerine bakıldı. Bulgular: Karaciğer nakli yapılan 34 hastadan sekizinde (%23,5) postoperatif erken dönemde ilk bir ayda akut rejeksiyon gelişti. Rejeksiyon gelişen hastalarda ALT ve AST değerlerinin tedavinin farklı aşamalarındaki değişimleri açışından anlamlı farklılıkların olduğu görüldü (p<0.005). Pre-transplantasyon ve taburculuk öncesi ölçülen hemoglobin, trombosit, nötrofil, lenfosit, ALT, AST ve serum glukoz değerleri arasında anlamlı farklılık tespit edilmedi (p>0.05). Rejeksiyon gelişen hastaların preoperatif albümin değeri, rejeksiyon gelişmeyen hastalardan anlamlı olarak daha düşüktü (p=0.040). Pre-transplantasyon CRP değerleri arasındaki fark anlamlı idi (p=0.035). Yapılan çoklu analizlerde, pre-transplantasyon dönemine göre rejeksiyon aşamasında nötrofil/lenfosit (p=0.026), AST/lenfosit (p=0.003), ALT/lenfosit (p<0.001) ve ALT/nötrofil (p=0.003) oranlarında anlamlı idi. Sonuç: Akut rejeksiyon transplantasyondan günler sonra ortaya çıkabilen ve greft kaybı ile sonuçlanabilen bir tablodur. Tedavisinde doğru tanıyı destekleyecek parametrelerin önemi her geçen gün daha da artmaktadır.

Kaynakça

  • 1. Justiz Vaillant AA, Misra S, Fitzgerald BM. Acute Transplantation Rejection. 2020 Dec 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30571031.
  • 2. Baba HA, Theurer S, Canbay A, Schwertheim S, Lainka E, Kälsch J at al. Aktuelle Aspekte der Prätransplantationsdiagnostik und Abstoßung [Liver transplantation. Current aspects of pretransplantation diagnosis and rejection]. Pathologe. 2020 Sep;41(5):505-514. German. doi: 10.1007/s00292-020-00813-9.
  • 3. Wiesner RH, Batts KP, Krom RA. Evolving concepts in the diagnosis, pathogenesis, and treatment of chronic hepatic allograft rejection. Liver Transpl Surg. 1999 Sep;5(5):388-400. doi: 10.1002/lt.500050519. PMID: 10477840.
  • 4. Daldal E, Akbas A, Dasiran MF, Dagmura H, Bakir H, Okan I. Prognostic importance of neutrophil / lymphocyte and lymphocyte / CRP ratio in cases with malignant bowel obstruction. Medicine Science 2019;8(4):927-30)
  • 5. Kohut TJ, Barandiaran JF, Keating BJ. Genomics and Liver Transplantation: Genomic Biomarkers for the Diagnosis of Acute Cellular Rejection. Liver Transpl. 2020 Oct;26(10):1337-1350. doi: 10.1002/lt.25812. Epub 2020 Jul 15. PMID: 32506790.
  • 6. Limsrichamrern S, Chanapul C, Mahawithitwong P at al. Correlation of Hematocrit and Tacrolimus Level in Liver Transplant Recipients. Transplant Proc. 2016 May;48(4):1176-8. doi: 10.1016/j.transproceed.2015.12.096. PMID: 27320581.
  • 7. Kuypers DR, Vanrenterghem Y. Time to reach tacrolimus maximum blood concentration,mean residence time, and acute renal allograft rejection: an open-label, prospective, pharmacokinetic study in adult recipients. Clin Ther. 2004 Nov;26(11):1834-44. doi: 10.1016/j.clinthera.2004.11.004. PMID: 15639695.
  • 8. Yoshikawa N, Urata S, Yasuda K at al. Retrospective analysis of the correlation between tacrolimus concentrations measured in whole blood and variations of blood cell counts in patients undergoing allogeneic haematopoietic stem cell transplantation. Eur J Hosp Pharm. 2020 Mar;27(e1):e7-e11. doi: 10.1136/ejhpharm-2018-001663. Epub 2018 Nov 16. PMID: 32296498; PMCID: PMC7147553.
  • 9. Csikány N, Kiss Á, Déri M at al. Clinical significance of personalized tacrolimus dosing by adjusting to donor CYP3A-status in liver transplant recipients. Br J Clin Pharmacol. 2020 Sep 28. doi: 10.1111/bcp.14566. Epub ahead of print. PMID: 32986876.
  • 10. Venkataramanan R, Shaw LM, Sarkozi L at al. Clinical utility of monitoring tacrolimus blood concentrations in liver transplant patients. J Clin Pharmacol. 2001 May;41(5):542-51. doi: 10.1177/00912700122010429. PMID: 11361051.
  • 11. Xie Z, Zhao H, Chen Y at al. The Role of Tacrolimus Nanomicelles in Acute Rejection After Liver Transplantation in Rats. J Nanosci Nanotechnol. 2021 Feb 1;21(2):1061-1069. doi: 10.1166/jnn.2021.18674. PMID: 33183444.
  • 12. Neuberger J. Incidence, timing, and risk factors for acute and chronic rejection. Liver Transpl Surg. 1999 Jul;5(4 Suppl 1):S30-6. doi: 10.1053/JTLS005s00030. PMID: 10431015.
  • 13. Mao JX, Guo WY, Guo M, Liu C, Teng F, Ding GS. Acute rejection after liver transplantation is less common, but predicts better prognosis in HBV-related hepatocellular carcinoma patients. Hepatol Int. 2020 May;14(3):347-361. doi: 10.1007/s12072-020-10022-4. Epub 2020 Mar 5. PMID: 32140981.
  • 14. Feng Y, Han Z, Wang X, Chen H, Li Y. Association of Graft-to-Recipient Weight Ratio with the Prognosis Following Liver Transplantation: a Meta-analysis. J Gastrointest Surg. 2020 Aug;24(8):1869-1879. doi: 10.1007/s11605-020-04598-3. Epub 2020 Apr 18. PMID: 32306226.

Parameters that may indicate early postoperative rejections in patients with liver transplantation.

Yıl 2021, Cilt 11, Sayı 4, 440 - 444, 31.07.2021

Öz

Aim: We aimed to investigate the importance of inflammatory parameters in determining acute rejection in the early post-operative period in liver transplant client. Materials and Methods: When rejection was developed and after pulse steroid therapy, Preoperative, Hemoglobin, Neutrophil / Lymphocyte rate, AST / Lymphocyte rate, AST / Neutrophil rate, ALT / Lymphocyte rate, ALT / Neutrophil rate, CRP / Albumin rate, Glucose, tacrolimus and GRWR (Graft recipient weight ratio) levels of clients who developed rejection in the early period after liver transplantation performed Yeditepe University Hospital in 2020 were measured. Preoperative and discharge values of the group without rejection were also evaluated. Results: Acute rejection developed in the first one month in the early postoperative period at eight (23.5%) of 34 clients who underwent liver transplantation. It was observed that there were significant differences in terms of changes in ALT and AST values at different stages of treatment in clients who developed rejection (p=0.01). The preoperative albumin value of the clients who developed rejection was significantly lower than the clients who did not develop rejection (p=0.040). The difference among pre-transplantation CRP values was significant (p = 0.035). In the multiple analyzes performed, the ratio of neutrophil/lymphocyte (p=0.026), AST/lymphocyte (p=0.003), ALT/lymphocyte (p<0.001) and ALT/neutrophil (p=0.003) at the rejection stage according to the pre-transplantation period was significant. Conclusion: Acute rejection can occur days after transplantation and may lead to graft failure. The importance of parameters that supports the correct diagnosis in treatment is increasing day by day.

Kaynakça

  • 1. Justiz Vaillant AA, Misra S, Fitzgerald BM. Acute Transplantation Rejection. 2020 Dec 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30571031.
  • 2. Baba HA, Theurer S, Canbay A, Schwertheim S, Lainka E, Kälsch J at al. Aktuelle Aspekte der Prätransplantationsdiagnostik und Abstoßung [Liver transplantation. Current aspects of pretransplantation diagnosis and rejection]. Pathologe. 2020 Sep;41(5):505-514. German. doi: 10.1007/s00292-020-00813-9.
  • 3. Wiesner RH, Batts KP, Krom RA. Evolving concepts in the diagnosis, pathogenesis, and treatment of chronic hepatic allograft rejection. Liver Transpl Surg. 1999 Sep;5(5):388-400. doi: 10.1002/lt.500050519. PMID: 10477840.
  • 4. Daldal E, Akbas A, Dasiran MF, Dagmura H, Bakir H, Okan I. Prognostic importance of neutrophil / lymphocyte and lymphocyte / CRP ratio in cases with malignant bowel obstruction. Medicine Science 2019;8(4):927-30)
  • 5. Kohut TJ, Barandiaran JF, Keating BJ. Genomics and Liver Transplantation: Genomic Biomarkers for the Diagnosis of Acute Cellular Rejection. Liver Transpl. 2020 Oct;26(10):1337-1350. doi: 10.1002/lt.25812. Epub 2020 Jul 15. PMID: 32506790.
  • 6. Limsrichamrern S, Chanapul C, Mahawithitwong P at al. Correlation of Hematocrit and Tacrolimus Level in Liver Transplant Recipients. Transplant Proc. 2016 May;48(4):1176-8. doi: 10.1016/j.transproceed.2015.12.096. PMID: 27320581.
  • 7. Kuypers DR, Vanrenterghem Y. Time to reach tacrolimus maximum blood concentration,mean residence time, and acute renal allograft rejection: an open-label, prospective, pharmacokinetic study in adult recipients. Clin Ther. 2004 Nov;26(11):1834-44. doi: 10.1016/j.clinthera.2004.11.004. PMID: 15639695.
  • 8. Yoshikawa N, Urata S, Yasuda K at al. Retrospective analysis of the correlation between tacrolimus concentrations measured in whole blood and variations of blood cell counts in patients undergoing allogeneic haematopoietic stem cell transplantation. Eur J Hosp Pharm. 2020 Mar;27(e1):e7-e11. doi: 10.1136/ejhpharm-2018-001663. Epub 2018 Nov 16. PMID: 32296498; PMCID: PMC7147553.
  • 9. Csikány N, Kiss Á, Déri M at al. Clinical significance of personalized tacrolimus dosing by adjusting to donor CYP3A-status in liver transplant recipients. Br J Clin Pharmacol. 2020 Sep 28. doi: 10.1111/bcp.14566. Epub ahead of print. PMID: 32986876.
  • 10. Venkataramanan R, Shaw LM, Sarkozi L at al. Clinical utility of monitoring tacrolimus blood concentrations in liver transplant patients. J Clin Pharmacol. 2001 May;41(5):542-51. doi: 10.1177/00912700122010429. PMID: 11361051.
  • 11. Xie Z, Zhao H, Chen Y at al. The Role of Tacrolimus Nanomicelles in Acute Rejection After Liver Transplantation in Rats. J Nanosci Nanotechnol. 2021 Feb 1;21(2):1061-1069. doi: 10.1166/jnn.2021.18674. PMID: 33183444.
  • 12. Neuberger J. Incidence, timing, and risk factors for acute and chronic rejection. Liver Transpl Surg. 1999 Jul;5(4 Suppl 1):S30-6. doi: 10.1053/JTLS005s00030. PMID: 10431015.
  • 13. Mao JX, Guo WY, Guo M, Liu C, Teng F, Ding GS. Acute rejection after liver transplantation is less common, but predicts better prognosis in HBV-related hepatocellular carcinoma patients. Hepatol Int. 2020 May;14(3):347-361. doi: 10.1007/s12072-020-10022-4. Epub 2020 Mar 5. PMID: 32140981.
  • 14. Feng Y, Han Z, Wang X, Chen H, Li Y. Association of Graft-to-Recipient Weight Ratio with the Prognosis Following Liver Transplantation: a Meta-analysis. J Gastrointest Surg. 2020 Aug;24(8):1869-1879. doi: 10.1007/s11605-020-04598-3. Epub 2020 Apr 18. PMID: 32306226.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Orjinal Araştırma
Yazarlar

Ramazan DÖNMEZ (Sorumlu Yazar)
YEDİTEPE ÜNİVERSİTESİ
0000-0003-2455-6380
Türkiye


Ufuk GÖKTUĞ Bu kişi benim
YEDİTEPE ÜNİVERSİTESİ
0000-0002-9164-560X
Türkiye


Ertan EMEK
YEDİTEPE ÜNİVERSİTESİ
0000-0003-0534-7866
Türkiye

Destekleyen Kurum yok
Proje Numarası -
Yayımlanma Tarihi 31 Temmuz 2021
Kabul Tarihi 2 Nisan 2021
Yayınlandığı Sayı Yıl 2021, Cilt 11, Sayı 4

Kaynak Göster

AMA Dönmez R. , Göktuğ U. , Emek E. Parameters that may indicate early postoperative rejections in patients with liver transplantation.. J Contemp Med. 2021; 11(4): 440-444.