Karaciğer transplantasyonu sonrasında abdominal sepsis gelişen hastalarda tranplante greftin sepsise yanıtının değerlendirilmesi
Küçük Resim Yok
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Sepsis, karmaşık patofizyolojik olayların etkili olduğu, mortalitesi yüksek, tedavisi zor bir tablodur. Karaciğer nakli olmuş ve abdominal kaynaklı sepsis gelişmiş hastalarda proinflamatuar, inflamatuar ve antiinflamatuar sitokinler, CRP, prokalsitonin, hematolojik ve biyokimyasal belirteçler ile transplante greftten alınan biyopsi örneklerinin histolojik olarak elektron mikroskopisi ve patolojik olarak ışık mikroskopisi altında yapılan doku incelemelerinin sonucunda transplante greftin sepsise yanıtının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışma, İnönü Üniversitesi Karaciğer Nakli Enstitüsü'nde karaciğer nakli yapılmış ve abdominal kaynaklı sepsis tanısı almış ardışık 24 hasta üzerinde prospektif olarak gerçekleştirildi. Hastaların yaş, cinsiyet, tanı, yatış süreleri, SOFA skorları, nakil endikasyonları, relaparotomi yapılmasına sebep olan sepsis etiyolojileri gibi tanımlayıcı verileri kaydedildi. Hastalardan alınan kan, batın içi sıvı, idrar ve solunum yolu örnekleri, laboratuvar değerleri kayıt altına alındı. Relaparotomi sonrasında transplante karaciğerden alınan biyopsi örnekleri uygun solüsyonlarda histoloji ve patoloji laboratuvarlarına gönderildi. Ayrıca inflamatuar sitokinlerin düzeyleri ölçülmek üzere kan örnekleri depolandı. Çalışma sonunda depolanan serum örneklerinden IL-4, IL-6, IL-10, IL-17, TREM1, sHLA-G, TNF-?, TGF-?, IFN-? değerleri çalışıldı. Bulgular: Çalışma sonucunda üç grup oluşturuldu ve kendi içinde değerlendirildi. Kültür pozitif ve negatif grupta retransplantasyon oranı anlamlı olarak farklıydı (%12.5 vs %50; p=0.046). Kültürde üreme olan hastalarda istatistiksel olarak anlamlı olmasa da mortalite daha fazlaydı (p=0.54). TREM-1 üreme olan grupta daha fazlaydı (1682 vs 1085.3 pg/mL; p=0.027). Üreme olmayan hastalarda AST ve ALT anlamlı olarak daha yüksekti (sırasıyla; p=0.03 ve p=0.004). Kültürde üreme olan ve olmayan grupta AST değerleri sırası ile 42.5 (13-14830) ve 111 (47-3070) IU/L idi. Kültürde üreme olan ve olmayan grupta ALT değerleri ise sırası ile 48.5 (13-5921) ve 195.5 (112-3276) IU/L idi. Survival grubunda erkek hastalarda mortalite oranı daha fazlaydı (%87,5 vs %12,5; p=0.02). Retransplantasyon yapılan hastalarda da mortalite oranı anlamlı olarak farklı bulundu (%50 vs %12; p=0.04). Mortalite gelişen hastaların yaşayanlarla karşılaştırılmasında fibrinojen istatistiksel olarak düşük bulunurken (97.6 vs 220 mg/dl; p=0.001), total bilirübin (18.3 vs 5.1 mg/dl; p=0.006 ) ve PTZ (20.5 vs 15.2 sn; p=0.009) anlamlı olarak yüksek bulundu. Cinsiyete göre değerlendirilen grupta ise AST, ALT, LDH, amonyak, laktat seviyeleri erkeklerde, kadınlara oranla anlamlı olarak yüksek görüldü (sırasıyla; p=0.012, p=0.016, p=0.014, p=0.03, p=0.048). Sadece fibrinojen düzeyleri kadınlarda istatistiksel olarak daha yüksek bulundu (p=0.04). Her üç grupta da diğer parametrelerde anlamlı bir farklılık yoktu. Elektron ve ışık mikroskobik incelemede; kolestaz, nekroz, hücre içi organel değişiklikleri, steatoz, doku rejeksiyonu gibi sepsisi destekleyen bulgulara rastlanıldı. Sonuç: Bu çalışma, karaciğer nakli sonrasında sepsis gelişmiş hastalarda birçok laboratuvar parametresi düzeyinin ve hücresel düzeyde doku değişikliklerinin gerçekleştiğini göstermektedir.
Introduction and Objective: Sepsis is a difficult condition to treat with high mortality and complex pathophysiological events. Blood samples were taken from the patients for the examination of cytokines, hematological, and biochemical markers. It was aimed to evaluate the sepsis response of patients who underwent liver transplantation and developed abdominal sepsis as a result of tissue examinations performed under histologically electron microscope and pathologically under the light microscope. Materials and Methods: This study was carried out prospectively on 24 consecutive patients who underwent liver transplantation at Inonu University Liver Transplantation Institute and were diagnosed with sepsis of abdominal origin. Descriptive data of the patients such as age, gender, diagnosis, length of stay, SOFA scores, transplant indications, sepsis etiology leading to relaparotomy were recorded. Blood, intraabdominal fluid, urine, respiratory samples and laboratory values taken from the patients were recorded. Biopsy samples taken from the transplanted liver after relaparotomy were sent to histology and pathology laboratories in appropriate solutions. In addition, blood samples were stored to measure the levels of inflammatory cytokines. IL-4, IL-6, IL-10, IL-17, TREM1, sHLA-G, TNF-?, TGF-?, IFN-? values were studied from the serum samples stored at the end of the study. Results: As a result of the study, three groups were formed and evaluated within themselves. The retransplantation rate was significantly different in the culture positive and negative groups (12.5% vs 50%; p= 0.046). Although it was not statistically significant in culture positive patients, mortality was higher (p=0.54). TREM-1 was higher in the culture positive group (1682 vs 1085.3 pg/ml; p=0.027). AST and ALT were significantly higher in culture negative patients (p= 0.03 and p=0.004, respectively). AST values were 42.5 (13-14830) and 111 (47-3070) IU/L in culture positive and culture negative groups, respectively. In culture positive and culture negative groups, ALT values were 48.5 (13-5921) and 195.5 (112-3276) IU/L, respectively. In the survival group, the mortality rate was higher in male patients (87.5% vs 12.5%; p=0.02). Mortality rate in patients with retransplantation was found to be significantly different than those without retransplantation (50% vs 12%; p=0.04). Fibrinogen was found to be statistically lower in patients with mortality compared to living patients (97.6 vs 220 mg/dl; p=0.001); however, total bilirubin (18.3 vs 5.1 mg/dl; p=0.006) and PTZ (20.5 vs 15.2 sec; p=0.009) were found to be significantly higher. In the group evaluated according to gender, AST, ALT, LDH, ammonia and lactate levels were found to be significantly higher in men than in women (respectively; p=0.012, p=0.016, p=0.014, p=0.03, p=0.048). Only fibrinogen levels were found to be statistically higher in women (p=0.04). There was no significant difference in other parameters in all three groups. In electron and light microscopic examination; symptoms supporting sepsis such as cholestasis, necrosis, intracellular organelle changes, steatosis, and tissue rejection were encountered. Conclusion: This study shows that many laboratory parameters and cellular tissue changes occur in patients with sepsis after liver transplantation.
Introduction and Objective: Sepsis is a difficult condition to treat with high mortality and complex pathophysiological events. Blood samples were taken from the patients for the examination of cytokines, hematological, and biochemical markers. It was aimed to evaluate the sepsis response of patients who underwent liver transplantation and developed abdominal sepsis as a result of tissue examinations performed under histologically electron microscope and pathologically under the light microscope. Materials and Methods: This study was carried out prospectively on 24 consecutive patients who underwent liver transplantation at Inonu University Liver Transplantation Institute and were diagnosed with sepsis of abdominal origin. Descriptive data of the patients such as age, gender, diagnosis, length of stay, SOFA scores, transplant indications, sepsis etiology leading to relaparotomy were recorded. Blood, intraabdominal fluid, urine, respiratory samples and laboratory values taken from the patients were recorded. Biopsy samples taken from the transplanted liver after relaparotomy were sent to histology and pathology laboratories in appropriate solutions. In addition, blood samples were stored to measure the levels of inflammatory cytokines. IL-4, IL-6, IL-10, IL-17, TREM1, sHLA-G, TNF-?, TGF-?, IFN-? values were studied from the serum samples stored at the end of the study. Results: As a result of the study, three groups were formed and evaluated within themselves. The retransplantation rate was significantly different in the culture positive and negative groups (12.5% vs 50%; p= 0.046). Although it was not statistically significant in culture positive patients, mortality was higher (p=0.54). TREM-1 was higher in the culture positive group (1682 vs 1085.3 pg/ml; p=0.027). AST and ALT were significantly higher in culture negative patients (p= 0.03 and p=0.004, respectively). AST values were 42.5 (13-14830) and 111 (47-3070) IU/L in culture positive and culture negative groups, respectively. In culture positive and culture negative groups, ALT values were 48.5 (13-5921) and 195.5 (112-3276) IU/L, respectively. In the survival group, the mortality rate was higher in male patients (87.5% vs 12.5%; p=0.02). Mortality rate in patients with retransplantation was found to be significantly different than those without retransplantation (50% vs 12%; p=0.04). Fibrinogen was found to be statistically lower in patients with mortality compared to living patients (97.6 vs 220 mg/dl; p=0.001); however, total bilirubin (18.3 vs 5.1 mg/dl; p=0.006) and PTZ (20.5 vs 15.2 sec; p=0.009) were found to be significantly higher. In the group evaluated according to gender, AST, ALT, LDH, ammonia and lactate levels were found to be significantly higher in men than in women (respectively; p=0.012, p=0.016, p=0.014, p=0.03, p=0.048). Only fibrinogen levels were found to be statistically higher in women (p=0.04). There was no significant difference in other parameters in all three groups. In electron and light microscopic examination; symptoms supporting sepsis such as cholestasis, necrosis, intracellular organelle changes, steatosis, and tissue rejection were encountered. Conclusion: This study shows that many laboratory parameters and cellular tissue changes occur in patients with sepsis after liver transplantation.
Açıklama
Anahtar Kelimeler
Genel Cerrahi, General Surgery
