Canlı vericili karaciğer naklinde küçük boyutlu greft kullanımı: boyut önemli mi?

Öz

Amaç: Canlı vericili karaciğer naklinde greft ağırlığının alıcı ağırlığına (GRWR) oranının %0,8'den yüksek olması tercih edilir. GRWR'si %0,8'in üzerinde olan alıcılar ile küçük GRWR'si olan alıcıları nakil sonrası komplikasyonlar ve sonuçlar açısından karşılaştırmayı amaçladık. Gereç ve yöntem: Ocak 2017-Temmuz 2022 tarihleri arasında İstinye Üniversitesi Hastanesi Karaciğer Nakli Ünitesi'nde canlı vericili karaciğer nakli yapılan hastaların verileri incelendi. Çalışma grubu hastaları GRWR<0,8% (Grup 1), GRWR %0,8-1 (Grup 2) ve GRWR>%1 (Grup 3) olarak sınıflandırıldı ve klinik veriler, komplikasyonlar ve mortalite oranları açısından karşılaştırıldı. Bulgular: 220 canlı donörden alınan karaciğer nakli alıcıları dahil edildi. Ortalama alıcı yaşı 53,6 (18-79) idi. Grup 1 (n=29), Grup 2 (n=70) ve Grup 3 (n=121) arasındaki karşılaştırmalı analiz, safra kaçağı oranları ve hastanede kalış süresi (p=0,033, p<0,05) açısından anlamlı farklılıklar ortaya koydu. Safra kaçağı oranları Grup 1'de %7,4, Grup 2'de %6, Grup 3'te %0,8 idi. Safra kaçağı oranı Grup 3'te Grup 1 ve Grup 2'ye göre anlamlı derecede düşüktü (p=0,041, p<0,05). Hastanede kalış sürelerinin ortancaları grup 1, 2 ve 3'te 18 (7-40) gün, 15 (5-46) gün ve 16 (1-130) gündü (p=0,033). Diğer parametreler açısından, üç grup benzer sonuçlar verdi. Sonuç: Canlı vericili karaciğer nakli sonrası GRWR değerinin 0,8'den düşük olması hastanede kalış süresini uzatan bir faktör, GRWR değerinin 1'den büyük olması ise biliyer komplikasyon riskini azaltan bir faktör gibi görünse de, bu farklılıklar toplam komplikasyon, akut rejeksiyon ve hasta sağkalımı oranlarını etkilememektedir.

Anahtar Kelimeler

• Greft alıcı ağırlık oranı
• karaciğer nakli
• canlı vericili

Using small size grafts in live donor liver transplantation: is size important?

Öz

Purpose: In living donor liver transplantation, it is preferred that the ratio of the weight of the graft to the weight of the recipient (GRWR) be higher than 0.8%. We aimed to compare recipients with a GRWR greater than 0.8% and those with a small GRWR regarding post-transplant complications and outcomes. Materials and methods: Data of the patients who had undergone living donor liver transplant surgery in İstinye University Hospital Liver Transplant Unit between January 2017 and July 2022 were reviewed. The study group patients were classified as GRWR<0.8% (Group 1), GRWR 0.8-1% (Group 2), and GRWR>1% (Group 3) and compared regarding clinical data, complications, and mortality rates. Results: Liver transplant recipients from 220 living donors were included. The mean recipient age was 53.6 (18-79). The comparative analysis between Group 1 (n=29), Group 2 (n=70), and Group 3 (n=121) revealed significant differences concerning the rates of bile leak and the length of hospital stay (p=0.033, p<0.05). Bile leak rates were 7.4% in Group 1, 6% in Group 2, and 0.8% in Group 3. The bile leakage rate was significantly lower in Group 3 than in Groups 1 and 2 (p=0.041, p<0.05). The medians of hospitalization periods were 18 (7-40) days, 15 (5-46) days, and 16 (1-130) days in groups 1, 2, and 3. In addition, the median length of stay was higher in Group 1 than in groups 2 and 3 (p=0.033). In terms of other parameters, the three groups gave similar results. Conclusion: Although a GRWR value of lower than 0.8 seems as a factor causing prolonged hospital stay, and a GRWR value of higher than 1 seems to lower the risk of biliary complications after a live donor liver transplantation, these changes are not associated with the changes in total complication and acute rejection rates and patient survival.

Anahtar Kelimeler

• Graft recipient weight ratio
• liver transplantation
• live donor

Kaynakça

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