Primer biliyer kolanjite bağlı karaciğer nakli yapılan hastaların uzun dönem sonuçları
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Primer biliyer kolanjit (PBK), kronik kolestaz, dolaşımdaki anti-mitokondriyal antikorlar (AMA),süpüratif olmayan kolanjit ve interlobüler safra kanalı hasarının karaciğer biyopsisi bulguları ile karakterize olan bir hastalıktır. PBK hastalarında karaciğer nakli, ilerlemiş hastalık için kesin tedavidir ve nakil sonrası 10 yıllık hayatta kalma oranı yaklaşık %70'tir. Çalışmamızdaki amaçlarımız karaciğer nakli yapılan hastaların nakil sonrası uzun dönem sonuçlarını araştırmaktır. Gereç ve Yöntem: Çalışmaya İnönü Üniversitesi Karaciğer Nakli Enstitüsünde Ocak 2004 ile Aralık 2023 tarihleri arasında PBK nedeniyle karaciğer nakli yapılan yetişkin hastalar dahil edildi. Klinik veriler hastaların retrospektif olarak yaş, cinsiyet, transplantasyon türü, transplantasyon öncesi ve sonrası AMA düzeyi, hiperlipidemi, osteoporoz varlığı, nakil endikasyonu, donörün yaşı, cinsiyeti, kan grubu, alıcı ile verici arasında akrabalık ilişkisi, nakil öncesi ve sonrası hepatosellüler karsinom olup olmadığı, nakil sonrası kullanılan immünsüpresif tedavi, nakil sonrası ursodeoksikolik asit (UDCA) veya steroid kullanım durumu, nakil sonrası hastanın survi oranları, nakil sonrası vefat eden hastalarda ölüm sebebi, nakil sonrası portal ven trombozu, hepatik ven trombozu, hepatik arter trombozu olup olmadığı varsa süresi, nakil sonrası rekürrens ve rejeksiyon gelişimi, nakil sonrası kaşıntı durumu, alp düzeyi, nakil sonrası kolanjiosellüler kanser olup olmadığı, ikinci ve üçüncü nakil olup olmadığı, nakil sonrası biliyer komplikasyon olduysa türü, nakil sonrası rekürrens ve rejeksiyon sıklıklarının incelenmesi planlandı. Bulgular: Çalışmaya 6'sı (%20,7) erkek ve 23'ü (%79,3) kadın olmak üzere toplam 29 hasta dahil edilmiştir. Hastaların yaş ortalaması 58,7±10,5 yıldı. 12 aylık, 36 aylık, 60 aylık ve 120 aylık sağkalım oranı sırasıyla %91,7, %75, %68,8, %57,3 şeklindedir. Nakillerin 2'si (%6,9) kadavra ve 27'si (%93,1) canlı donörden alınmıştı. Hastalarda rekürrens oranı %17,2 rejeksiyon oranı %17,2, biliyer komplikasyon oranı %17.2 olarak saptandı. 5 hastada portal ven trombozu ve 2 hastada hepatik arter trombozu olmak üzere toplam 7 hastada (%24.1) vasküler komplikasyon saptandı. Nakil sonrası ölüm oranını etkileyen faktörler analiz edildiğinde sadece immunsupresif dışı kortikosteroid ve UDCA tedavi kullanımının anlamlı etki ettiği saptandı. Tartışma: Sonuçlarımız başka tedavi seçeneği kalmamış son dönem PBK hastalarında karaciğer transplantasyonunun oldukça yüz güldürücü bir tedavi olduğunu ve nakil sonrası immunsupresif dışı kortikosteroid ve UDCA tedavisinin bu hasta grubunda son derece hayati ve önemli olduğunu düşündürmektedir. Anahtar Kelimeler: Primer biliyer kolanjit, Karaciğer transplantasyonu
Introduction: Primary biliary cholangitis (PCa) is a disease characterized by chronic cholestasis, circulating anti-mitochondrial antibodies (AMA), non-suppurative cholangitis and liver biopsy findings of interlobular bile duct injury. Liver transplantation is the definitive treatment for advanced disease in patients with PCa and the 10-year survival rate after transplantation is approximately 70%. The aim of this study was to investigate the long-term outcome of patients who underwent liver transplantation. Materials and Methods: The study included adult patients who underwent liver transplantation for primary biliary cholangitis at Inonu University Liver Transplant Institute between January 2004 and December 2023. Clinical data were retrospectively analyzed for age, gender, type of transplantation, AMA level before and after transplantation, presence of hyperlipidemia, osteoporosis, indication for transplantation, age, gender, blood type of the donor, consanguinity between the donor and the recipient, presence of hepatocellular carcinoma before and after transplantation, immunosuppressive therapy used after transplantation, ursodeoxycholic acid (UDCA) or steroid use status after transplantation, survival rates of the patient after transplantation, cause of death in patients who died after transplantation, portal vein thrombosis, hepatic vein thrombosis, hepatic artery thrombosis after transplantation, duration if any, recurrence and rejection development after transplantation, ıtching status after transplantation, alp level, cholangiocellular cancer after transplantation, second and third n. Results: A total of 29 patients, 6 (20.7%) males and 23 (79.3%) females, were included in the study. The mean age of the patients was 58.7±10.5 years. The 12-month, 36-month, 60-month and 120-month survival rates were 91.7%, 75%, 68.8% and 57.3%, respectively. Of the transplants, 2 (6.9%) were cadaveric and 27 (93.1%) were from living donors. Recurrence rate was 17.2%, rejection rate was 17.2% and biliary complication rate was 17.2%. A total of 7 patients (24.1%) had vascular complications, including portal vein thrombosis in 5 patients and hepatic artery thrombosis in 2 patients. When the factors affecting the post-transplant mortality rate were analyzed, only the use of non-immunosuppressive corticosteroids and UDCA treatment had a significant effect. Discussion: Our results suggest that liver transplantation is a highly promising treatment in end-stage PCa patients with no other treatment options and that post-transplant non-immunosuppressive corticosteroid and UDCA treatment is extremely vital and important in this patient group. Keywords: Primary biliary cholangitis, Liver transplantation
Introduction: Primary biliary cholangitis (PCa) is a disease characterized by chronic cholestasis, circulating anti-mitochondrial antibodies (AMA), non-suppurative cholangitis and liver biopsy findings of interlobular bile duct injury. Liver transplantation is the definitive treatment for advanced disease in patients with PCa and the 10-year survival rate after transplantation is approximately 70%. The aim of this study was to investigate the long-term outcome of patients who underwent liver transplantation. Materials and Methods: The study included adult patients who underwent liver transplantation for primary biliary cholangitis at Inonu University Liver Transplant Institute between January 2004 and December 2023. Clinical data were retrospectively analyzed for age, gender, type of transplantation, AMA level before and after transplantation, presence of hyperlipidemia, osteoporosis, indication for transplantation, age, gender, blood type of the donor, consanguinity between the donor and the recipient, presence of hepatocellular carcinoma before and after transplantation, immunosuppressive therapy used after transplantation, ursodeoxycholic acid (UDCA) or steroid use status after transplantation, survival rates of the patient after transplantation, cause of death in patients who died after transplantation, portal vein thrombosis, hepatic vein thrombosis, hepatic artery thrombosis after transplantation, duration if any, recurrence and rejection development after transplantation, ıtching status after transplantation, alp level, cholangiocellular cancer after transplantation, second and third n. Results: A total of 29 patients, 6 (20.7%) males and 23 (79.3%) females, were included in the study. The mean age of the patients was 58.7±10.5 years. The 12-month, 36-month, 60-month and 120-month survival rates were 91.7%, 75%, 68.8% and 57.3%, respectively. Of the transplants, 2 (6.9%) were cadaveric and 27 (93.1%) were from living donors. Recurrence rate was 17.2%, rejection rate was 17.2% and biliary complication rate was 17.2%. A total of 7 patients (24.1%) had vascular complications, including portal vein thrombosis in 5 patients and hepatic artery thrombosis in 2 patients. When the factors affecting the post-transplant mortality rate were analyzed, only the use of non-immunosuppressive corticosteroids and UDCA treatment had a significant effect. Discussion: Our results suggest that liver transplantation is a highly promising treatment in end-stage PCa patients with no other treatment options and that post-transplant non-immunosuppressive corticosteroid and UDCA treatment is extremely vital and important in this patient group. Keywords: Primary biliary cholangitis, Liver transplantation
Açıklama
Anahtar Kelimeler
İç Hastalıkları, Internal diseases
