Karaciğer nakli sonrası biliyer striktür nedeniyle ERCP uygulanan hastalarda NOD2 varyant sıklığının işlem sonrası klinik seyir üzerine etkileri
Küçük Resim Yok
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Donör yaşı, uzamış soğuk ve sıcak iskemi süresi, cerrahi teknikler ve hepatik arter trombozunun gelişimi canlı donör karaciğer transplantasyonu (LDLT) sonrası biliyer darlık oluşumunda iyi bilinen risk faktörleridir. Bu sorunların üstesinden gelmek için yoğun çabalar sarf edilmesine rağmen, biliyer darlıklar LDLT'den sonra hala en önemli morbidite ve mortalite nedenlerinden biridir. Nükleotit bağlayıcı oligomerizasyon alanı 2 (NOD2) doğal immün sistemin bir komponentidir ve karaciğer, makrofajlar, dendritik hücrelerde eksprese edildiği gibi intestinal epitelin Paneth hücrelerinde de eksprese edilir. NOD2, bakteri duvar peptitlerini algılayıp yanıt veren NOD benzeri reseptör ailesinin bir üyesidir. Bu protein, konakçı bağışıklık sistemi ve bağırsak florası elemanları arasındaki dengeyi kolaylaştırır, çeşitli anti-bakteriyel bileşiklerin salgılanmasını düzenler. Bir çalışmada R702W NOD2 varyantının ortotopik karaciğer transplantasyonu sonrası artmış bakteriyel enfeksiyon riski ile ilişkili olduğu bildirilmiştir. Bu çalışmada, LDLT sonrası biliyer darlık nedeniyle endoskopik tedavi uygulanan hastalarda bazı NOD2 varyantlarının (p.G908R, c.3020insC, p.R702W ve 1007fs) hastanede kalış süresi ve endoskopik tedavi sonuçları üzerindeki etkilerini araştırdık. Materyal ve Metot: Canlıdan canlıya karaciğer transplantasyonu sonrası biliyer striktür nedeniyle endoskopik retrograd kolanjiopankreatografi (ERCP) uygulanan hastaların yaş, cinsiyet, transplantasyondan sonra ERCP'ye kadar geçen süreleri, ERCP bulguları, ve hastanede yatış süreleri kaydedildi. Çalışmaya dâhil edilen hastalar iki gruba ayrıldı. Grup 1: ERCP sonrası ilk 24 saatte taburcu edilenler ve Grup 2: ERCP sonrası ilk 24 saatten sonra taburcu edilenler. Her iki grup arasında 4 adet NOD2 varyant sıklığı araştırıldı. Bulgular: ERCP sonrası ilk 24 saatten sonra taburcu edilen grupta striktürü geçilemeyen hasta sayısı diğer gruptan anlamlı şekilde yüksekti (%34'e %0, p<0.0001). Çalışmamızda p.R702W mutasyonu ERCP sonrası ilk 24 saatte taburcu edilenler grubunda hiçbir hastada saptanmaz iken, ERCP sonrası ilk 24 saatten sonra taburcu edilenler grubunda 10 hastada saptandı. İki grup arasında p.R702W mutasyon sıklığı istatistiksel olarak anlamlı şekilde farklıydı (p:0.002). 1007fs mutasyonu ERCP sonrası ilk 24 saatte taburcu edilenler grubunda 3 hastada saptandı. Buna karşın bu mutasyon ERCP sonrası ilk 24 saatten sonra taburcu edilenler grubunda 14 hastada saptandı. İki grup arasında 1007fs mutasyon sıklığı istatistiksel olarak anlamlı şekilde farklıydı (p:0.011). Sonuç: Sonuçlarımız özellikle p.R702W varyantı başta olmak üzere NOD2 varyantlarının karaciğer nakil hastalarında ERCP işlemi sonrası hastanede yatış süresi üzerinde bir role sahip olduğunu düşündürmektedir. Anahtar Kelimler: Karaciğer nakli, ERCP, Biliyer striktür, NOD2
Introduction and aims: Donor age, prolonged cold and warm ischemia time, surgical techniques and development of hepatic artery thrombosis are well-known risk factors for biliary stricture after live donor liver transplantation (LDLT). Although intensive efforts have been made to overcome these problems, biliary stricture is still one of the most important causes of morbidity and mortality after LDLT. Nucleotide-binding oligomerization domain containing 2 (NOD2) is a component of the innate immune system and is expressed in liver, macrophages, dendritic cells as well as in Panet cells of the intestinal epithelium. NOD2 is a member of the NOD-like receptor family that recognizes and responds to bacterial wall peptides. This protein facilitates the balance between the host immune system and intestinal flora elements, regulates the secretion of various antibacterial compounds. In a study, R702W NOD2 variant was reported to be associated with increased risk of bacterial infection after orthotopic liver transplantation. In this study, we investigated the effects of some NOD2 variants (p.G908R, c.3020insC, p.R702W and 1007fs) on endoscopic treatment results and length of hospital stay in patients underwent endoscopic treatment for biliary stricture after LDLT. Materials and Methods: Age, sex, time to ERCP after transplantation, ERCP findings, and hospitalization time of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for biliary stricture after LDLT were recorded. Patients included in the study were divided into two groups. Group 1: Discharged in the first 24 hours after ERCP and Group 2: Discharged after the first 24 hours after ERCP. The frequency of four NOD2 variants was investigated between the two groups. Results: In the group discharged after the first 24 hours after ERCP, the number of patients whose stricture could not be passed was significantly higher than the other group (34% vs 0%, p <0.0001). In our study, p.R702W mutation was not detected in any of the patients discharged in the first 24 hours after ERCP, whereas it was detected in 10 patients who were discharged after the first 24 hours after ERCP. The frequency of p.R702W mutation was significantly different between the two groups (p: 0.002). 1007fs mutation was detected in 3 patients in the first 24 hours after ERCP. However, this mutation was detected in 14 patients in the group discharged after the first 24 hours after ERCP. The frequency of 1007fs mutations between the two groups was statistically significant (p: 0.011). Conclusion: Our results suggest that NOD2 variants, especially the p.R702W variant, have a role on the length of hospital stay in liver transplant patients after ERCP procedure. Keywords: Liver transplantation, ERCP, Biliary stricture, NOD2
Introduction and aims: Donor age, prolonged cold and warm ischemia time, surgical techniques and development of hepatic artery thrombosis are well-known risk factors for biliary stricture after live donor liver transplantation (LDLT). Although intensive efforts have been made to overcome these problems, biliary stricture is still one of the most important causes of morbidity and mortality after LDLT. Nucleotide-binding oligomerization domain containing 2 (NOD2) is a component of the innate immune system and is expressed in liver, macrophages, dendritic cells as well as in Panet cells of the intestinal epithelium. NOD2 is a member of the NOD-like receptor family that recognizes and responds to bacterial wall peptides. This protein facilitates the balance between the host immune system and intestinal flora elements, regulates the secretion of various antibacterial compounds. In a study, R702W NOD2 variant was reported to be associated with increased risk of bacterial infection after orthotopic liver transplantation. In this study, we investigated the effects of some NOD2 variants (p.G908R, c.3020insC, p.R702W and 1007fs) on endoscopic treatment results and length of hospital stay in patients underwent endoscopic treatment for biliary stricture after LDLT. Materials and Methods: Age, sex, time to ERCP after transplantation, ERCP findings, and hospitalization time of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for biliary stricture after LDLT were recorded. Patients included in the study were divided into two groups. Group 1: Discharged in the first 24 hours after ERCP and Group 2: Discharged after the first 24 hours after ERCP. The frequency of four NOD2 variants was investigated between the two groups. Results: In the group discharged after the first 24 hours after ERCP, the number of patients whose stricture could not be passed was significantly higher than the other group (34% vs 0%, p <0.0001). In our study, p.R702W mutation was not detected in any of the patients discharged in the first 24 hours after ERCP, whereas it was detected in 10 patients who were discharged after the first 24 hours after ERCP. The frequency of p.R702W mutation was significantly different between the two groups (p: 0.002). 1007fs mutation was detected in 3 patients in the first 24 hours after ERCP. However, this mutation was detected in 14 patients in the group discharged after the first 24 hours after ERCP. The frequency of 1007fs mutations between the two groups was statistically significant (p: 0.011). Conclusion: Our results suggest that NOD2 variants, especially the p.R702W variant, have a role on the length of hospital stay in liver transplant patients after ERCP procedure. Keywords: Liver transplantation, ERCP, Biliary stricture, NOD2
Açıklama
Anahtar Kelimeler
Gastroenteroloji, Gastroenterology
