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Portal ven Trombozunun Karaciğer Nakli Sonuçları Üzerindeki Etkisi

Yıl 2023, Cilt: 45 Sayı: 4, 487 - 494, 20.07.2023
https://doi.org/10.20515/otd.1271261

Öz

Portal ven trombozu (PVT), karaciğer transplantasyonu bekleyen hastaların %17,9 kadarında görülür. Bu durum, karaciğer nakli sonrası sağkalımı olumsuz etkileyebilir. Ocak 2020-Haziran 2021 tarihleri arasında nakil merkezimizde gerçekleştirilen karaciğer nakli ameliyatları tarandı. Veriler geriye dönük olarak elektronik dosya sisteminden toplandı. Alıcının cinsiyeti, yaşı, nakil endikasyonu, hepatosellüler karsinom varlığı, rejeksiyon atakları, yoğun bakım ünitesinde geçirilen gün sayısı, hastanede kalış süresi, komplikasyonlar, mortalite nedenleri ve ilgili risk faktörleri kaydedildi. PVT olmayan hastalar kontrol grubunu oluşturdu. PVT'li hastalar çalışma grubu olarak kabul edildi. Çalışma grupları arasındaki farkın anlamlılığını değerlendirmek için Student t-testi ve Mann-Whitney U testi kullanıldı. Toplamda, çalışma süresi içinde 223 karaciğer nakli gerçekleştirildi. Yeniden nakil olan 3 hasta çalışmadan çıkarıldı. 220 karaciğer nakli hastası üzerinde yapılan analizler hastaların %18,2'sinin (n=20) karaciğer nakli öncesinde PVT pozitif olduğunu gösterdi. PVT'li hastalar, daha yüksek non-alkolik steatohepatit oranına sahipti. Ek olarak, PVT varlığının cerrahi mortaliteyi ve erken rejeksiyon oranlarını önemli ölçüde arttırdığı gözlendi. Bununla bağlantılı olarak PVT'li hasta grubunda yoğun bakımda kalış süresi daha uzundu. Karaciğer nakli sonrası cerrahi mortalite PVT'li grupta daha yüksek olmasına rağmen, bu çalışmada altta yatan nedenler tespit edilmemiştir. Bununla birlikte, karaciğer transplantasyonunu takiben PVT'li hastalarda geç mortalite oranları daha yüksek değildi.

Kaynakça

  • 1. Venkatachalam AB, Livingstone SM, Hu Q, et al. Delivery of Soluble Heme Oxygenase 1 Cell-Penetrating Peptide into Liver Cells in in vitro and ex vivo Models of Cold Ischemia. Eur Surg Res. 2017;58:51-68.
  • 2. Varma V, Mehta N, Kumaran V, Nundy S. Indications and contraindications for liver transplantation. Int J Hepatol. 2011;2011:121862.
  • 3. Olson JC, Subramanian R, Karvellas CJ. Intensive care management of liver transplant recipients. Curr Opin Crit Care. 2022 Oct 14. doi: 10.1097/MCC.0000000000001002.
  • 4. Naidu SG, Alzubaidi SJ, Patel IJ, et al. Interventional Radiology Management of Adult Liver Transplant Complications. Radiographics. 2022;42:1705-1723.
  • 5. Uddin S, Ullah K, Dogar AW, Abbas SH, Khoso S, Ahmed B. An Innovation in the Technique of Recipient Hepatectomy in Living Donor Liver Transplantation. J Coll Physicians Surg Pak. 2022;32:1060-1063.
  • 6. Dulundu E, Sugawara Y, Makuuchi M. Revolution and refinement of surgical techniques for living donor partial liver transplantation. Yonsei Med J. 2004;45:1076-1088.
  • 7. Ak C, Adali G, Sayar S, et al. Portal vein thrombosis risk factors in liver transplant candidates. Hepatol Forum. 2022;3:88-92.
  • 8. Wang L, Guo X, Bai Z, et al. Impact of Asymptomatic Superior Mesenteric Vein Thrombosis on the Outcomes of Patients with Liver Cirrhosis. Thromb Haemost. 2022 Sep 30. doi: 10.1055/s-0042-1756648. [Epub ahead of print].
  • 9. Agbim U, Satapathy SK. PRO: Portal Vein Thrombosis Impacts Liver Transplantation Outcomes. Clin Liver Dis (Hoboken). 2020;16:127-131.
  • 10. Yerdel MA, Gunson B, Mirza D, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation. 2000;69:1873-1881.
  • 11. Yang Z, Wang S, Lerut J, Zhuang L, Zheng S. Portal inflow reconstruction for liver transplantation with portal vein thrombosis. Hepatobiliary Surg Nutr. 2021;10:291-294.
  • 12. Teng F, Sun KY, Fu ZR. Tailored classification of portal vein thrombosis for liver transplantation: Focus on strategies for portal vein inflow reconstruction. World J Gastroenterol. 2020;26:2691-2701.
  • 13. Chawla YK, Bodh V. Portal vein thrombosis. J Clin Exp Hepatol. 2015;5:22-40.
  • 14. Rugivarodom M, Charatcharoenwitthaya P. Nontumoral Portal Vein Thrombosis: A Challenging Consequence of Liver Cirrhosis. J Clin Transl Hepatol. 2020;8:432-444.
  • 15. Gaballa D, Bezinover D, Kadry Z, et al. Development of a Model to Predict Portal Vein Thrombosis in Liver Transplant Candidates: The Portal Vein Thrombosis Risk Index. Liver Transpl. 2019;25:1747-1755.
  • 16. Nery F, Chevret S, Condat B, et al. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: results of a longitudinal study. Hepatology. 2015;61:660-667.
  • 17. Anton A, Campreciós G, Pérez-Campuzano V, Orts L, García-Pagán JC, Hernández-Gea V. The Pathophysiology of Portal Vein Thrombosis in Cirrhosis: Getting Deeper into Virchow's Triad. J Clin Med. 2022;11:800.
  • 18. Cimen S, Guler S, Ayloo S, Molinari M. Implications of Hyponatremia in Liver Transplantation. J Clin Med. 2014;4:66-74.
  • 19. Ren W, Zhang J, Chen Y, et al. Evaluation of Coagulation, Fibrinolysis and Endothelial Biomarkers in Cirrhotic Patients With or Without Portal Venous Thrombosis. Clin Appl Thromb Hemost. 2020;26:1076029620982666.
  • 20. Shalaby S, Simioni P, Campello E, et al. Endothelial Damage of the Portal Vein is Associated with Heparin-Like Effect in Advanced Stages of Cirrhosis. Thromb Haemost. 2020;120:1173-1181.
  • 21. Wang X, Chen L. Letter to the editor: Treating portal vein thrombosis in cirrhosis: is anticoagulation therapy overestimated? Hepatol Int. 2022;16:1248-1249.

Impact of Portal Vein Thrombosis on the Outcomes of Liver Transplantation

Yıl 2023, Cilt: 45 Sayı: 4, 487 - 494, 20.07.2023
https://doi.org/10.20515/otd.1271261

Öz

Portal vein thrombosis (PVT) occurs in up to 17.9% of patients awaiting liver transplantation. It may impact post-liver transplantation survival negatively. The liver transplant procedures performed in our transplant center between January 2020 and June 2021 were screened. Data were collected retrospectively from the electronic folder system. Data, including causes of mortality, recipient gender, age, transplant indication, presence of hepatocellular carcinoma, rejection episodes, number of days in the intensive care unit, hospitalization duration, and complications, were recorded. Patients with no PVT constituted the control group. Patients with PVT were considered as the study group. Student’s t-test and the Mann-Whitney U test were used to evaluate the significance of the difference between study groups. Overall, 223 liver transplants were performed within the study period. Three re-transplants were excluded from the study. The analysis of 220 liver transplant patients revealed that 18.2% (n=20) of the patients presented with a PVT before liver transplantation. Patients with PVT had a higher rate of non-alcoholic steatohepatitis as an indication of a liver transplant. In addition, the presence of PVT significantly increased surgical mortality and early rejection rates. In correlation with this, the intensive care unit stay was longer in the patient group with PVT. Although the early surgical mortality post-liver transplant was higher in the group with PVT, the underlying variables could not be identified in this study. Nevertheless, the late mortality rates were not higher in patients with PVT following liver transplantation

Kaynakça

  • 1. Venkatachalam AB, Livingstone SM, Hu Q, et al. Delivery of Soluble Heme Oxygenase 1 Cell-Penetrating Peptide into Liver Cells in in vitro and ex vivo Models of Cold Ischemia. Eur Surg Res. 2017;58:51-68.
  • 2. Varma V, Mehta N, Kumaran V, Nundy S. Indications and contraindications for liver transplantation. Int J Hepatol. 2011;2011:121862.
  • 3. Olson JC, Subramanian R, Karvellas CJ. Intensive care management of liver transplant recipients. Curr Opin Crit Care. 2022 Oct 14. doi: 10.1097/MCC.0000000000001002.
  • 4. Naidu SG, Alzubaidi SJ, Patel IJ, et al. Interventional Radiology Management of Adult Liver Transplant Complications. Radiographics. 2022;42:1705-1723.
  • 5. Uddin S, Ullah K, Dogar AW, Abbas SH, Khoso S, Ahmed B. An Innovation in the Technique of Recipient Hepatectomy in Living Donor Liver Transplantation. J Coll Physicians Surg Pak. 2022;32:1060-1063.
  • 6. Dulundu E, Sugawara Y, Makuuchi M. Revolution and refinement of surgical techniques for living donor partial liver transplantation. Yonsei Med J. 2004;45:1076-1088.
  • 7. Ak C, Adali G, Sayar S, et al. Portal vein thrombosis risk factors in liver transplant candidates. Hepatol Forum. 2022;3:88-92.
  • 8. Wang L, Guo X, Bai Z, et al. Impact of Asymptomatic Superior Mesenteric Vein Thrombosis on the Outcomes of Patients with Liver Cirrhosis. Thromb Haemost. 2022 Sep 30. doi: 10.1055/s-0042-1756648. [Epub ahead of print].
  • 9. Agbim U, Satapathy SK. PRO: Portal Vein Thrombosis Impacts Liver Transplantation Outcomes. Clin Liver Dis (Hoboken). 2020;16:127-131.
  • 10. Yerdel MA, Gunson B, Mirza D, et al. Portal vein thrombosis in adults undergoing liver transplantation: risk factors, screening, management, and outcome. Transplantation. 2000;69:1873-1881.
  • 11. Yang Z, Wang S, Lerut J, Zhuang L, Zheng S. Portal inflow reconstruction for liver transplantation with portal vein thrombosis. Hepatobiliary Surg Nutr. 2021;10:291-294.
  • 12. Teng F, Sun KY, Fu ZR. Tailored classification of portal vein thrombosis for liver transplantation: Focus on strategies for portal vein inflow reconstruction. World J Gastroenterol. 2020;26:2691-2701.
  • 13. Chawla YK, Bodh V. Portal vein thrombosis. J Clin Exp Hepatol. 2015;5:22-40.
  • 14. Rugivarodom M, Charatcharoenwitthaya P. Nontumoral Portal Vein Thrombosis: A Challenging Consequence of Liver Cirrhosis. J Clin Transl Hepatol. 2020;8:432-444.
  • 15. Gaballa D, Bezinover D, Kadry Z, et al. Development of a Model to Predict Portal Vein Thrombosis in Liver Transplant Candidates: The Portal Vein Thrombosis Risk Index. Liver Transpl. 2019;25:1747-1755.
  • 16. Nery F, Chevret S, Condat B, et al. Causes and consequences of portal vein thrombosis in 1,243 patients with cirrhosis: results of a longitudinal study. Hepatology. 2015;61:660-667.
  • 17. Anton A, Campreciós G, Pérez-Campuzano V, Orts L, García-Pagán JC, Hernández-Gea V. The Pathophysiology of Portal Vein Thrombosis in Cirrhosis: Getting Deeper into Virchow's Triad. J Clin Med. 2022;11:800.
  • 18. Cimen S, Guler S, Ayloo S, Molinari M. Implications of Hyponatremia in Liver Transplantation. J Clin Med. 2014;4:66-74.
  • 19. Ren W, Zhang J, Chen Y, et al. Evaluation of Coagulation, Fibrinolysis and Endothelial Biomarkers in Cirrhotic Patients With or Without Portal Venous Thrombosis. Clin Appl Thromb Hemost. 2020;26:1076029620982666.
  • 20. Shalaby S, Simioni P, Campello E, et al. Endothelial Damage of the Portal Vein is Associated with Heparin-Like Effect in Advanced Stages of Cirrhosis. Thromb Haemost. 2020;120:1173-1181.
  • 21. Wang X, Chen L. Letter to the editor: Treating portal vein thrombosis in cirrhosis: is anticoagulation therapy overestimated? Hepatol Int. 2022;16:1248-1249.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Eryigit Eren 0000-0001-6705-4095

Ayhan Dinçkan 0000-0003-1395-333X

Yayımlanma Tarihi 20 Temmuz 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 45 Sayı: 4

Kaynak Göster

Vancouver Eren E, Dinçkan A. Impact of Portal Vein Thrombosis on the Outcomes of Liver Transplantation. Osmangazi Tıp Dergisi. 2023;45(4):487-94.


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