Karaciğer nakli yapılan hastalarda postoperatif erken dönemdeki rejeksiyonların göstergesi olabilecek parametreler

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

Ramazan Dönmez Ufuk Göktuğ Ertan Emek

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.

Anahtar Kelimeler

Karaciğer transplantasyonu, rejeksiyon, immünosüpresyon

Destekleyen Kurum

yok

Proje Numarası

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

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.

Anahtar Kelimeler

Liver transplantation, rejection, immunosuppression

Proje Numarası

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Kaynakça

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