Canlı vericili karaciğer naklinde loupe gözlükle hepatik arter rekonstrüksiyonu ve erken dönem hepatik arter trombozlarımız: 10 yıllık deneyim
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmanın amacı son 10 yıllık dönemde CVKN sonrası postoperatif erken dönemde ( ilk 7 gün) HAT gelişen hastalarda tedavi yaklaşımımızı, tedavi başarısını, tedavi başarısını etkileyen faktörleri ve sonuçlarımızı incelemektir. Gereç ve Yöntem: İnönü Üniversitesi Karaciğer Nakli Enstitüsü'nde Ocak 2013- Mayıs 2023 tarihleri arasında 2545 ardışık karaciğer nakli yapılan hastaların tıbbi kayıtları geriye dönük tarandı. Kadavra vericili karaciğer nakli yapılan 288 hasta çalışma dışı bırakıldı. Geriye kalan ve CVKN yapılan 2257 hastanın takiplerinde CVKN sonrası ilk yedi gün içerisinde HAT gelişen 64 hasta çalışmaya dahil edildi. CVKN sonrası ilk yedi gün içerisinde HAT gelişmesine rağmen greft arterinde endotel diseksiyonu olması nedeni ile ilk nakil ameliyatında başarılı bir HAR yapılamamış olan 6 hasta çalışmadan çıkarıldı. Geriye kalan 58 hastanın demografik özellikleri (yaş, cinsiyet), nakil endikasyonları, hepatik arter rekonstrüksiyonu yapılan alıcı arteri, intraoperatif HAT durumu, HAT günü, HAT tanısında kullanılan radyolojik görüntüleme yöntemleri, revizyonda hangi arterler arasında anastomoz yapıldığı, revizyon sayısı, revizyon başarısı, retransplantasyon durumu ve postoperatif biliyer komplikasyonları geriye dönük olarak incelendi. Bulgular: CVKN sonrası erken HAT insidansımız % 2,5 olarak saptandı. Bu oran çocuklarda % 3,1, erişkinlerde % 2,4 idi. HAT tanısı için geçen median süre bir gündü (0-7 gün). Erken HAT olan 46 hastaya ilk tedavi olarak trombektomi ve reanastomoz yapıldı. Trombektomi ve reanastomozda başarı oranımız % 50 olarak saptandı. Trombektomi ve reanastamoz başarılı olunan 2 hastaya PNF nedeniyle retransplantasyon yapıldı. Trombektomi ve reanastomozun başarısız olduğu 14 hastaya retransplantasyon yapıldı. Sekiz hastaya ise ilk tedavi olarak retransplantasyon yapıldı. Üç hasta klinik durumları kötü olduğu için cerrahiye alınamadı. Bir yıllık ve beş yıllık hasta sağkalımı sırası ile reanastomoz yapılanlarda % 50 ile % 45, retransplantasyon yapılanlarda % 67,9 ile % 54,4 idi. Bir yıllık ve beş yıllık greft sağkalımı % 24,1 idi. Sonuçlar: Erken HAT gelişen hastalarda erken teşhis, trombektomi ve reanastomoz hastayı ve grefti kurtarmak için tercih edilecek ilk tedavi olabilir. Başarısız bir reanastomoz sonrası, retransplantasyon en iyi prognoza sahip tedavi yöntemidir. Anahtar Kelimeler: canlı vericili karaciğer nakli, hepatik arter rekonstrüksiyonu, hepatik arter trombozu.
Aim: The aim of this study is to examine our treatment approach, treatment success, factors affecting treatment success, and our results in patients who developed HAT in the early postoperative period (first 7 days) after LDLT in the last 10 years. Material and Method: Medical records of 2545 consecutive liver transplant patients who underwent liver transplantation between January 2013 and May 2023 at Inonu University Liver Transplant Institute were retrospectively reviewed. We excluded 288 patients who underwent cadaveric liver transplantation. In the follow-up of the remaining 2257 patients who underwent LDLT, 64 who patients developed HAT within the first seven days after LDLT were included in the study. Six patients who developed HAT within the first seven days after LDLT but could not undergo successful HAR in the first transplantation operation, because of endothelial dissection in the graft artery were excluded from the study. Demographic characteristics (age, gender), indications for transplantation, recipient artery of hepatic artery reconstruction, intraoperative HAT status, HAT day, radiologic imaging methods used in the diagnosis of HAT, anastomosis between which arteries in revision, number of revisions, revision success, retransplantation status and postoperative biliary complications of the remaining 58 patients were retrospectively analyzed. Results: The incidence of early HAT after LDLT was 2.5% in study group. It was 3.1% in children and 2.4% in adults. The median time to diagnosis of HAT was one day (0-7 days). Thrombectomy and reanastomosis were performed as initial treatment in 46 patients with early HAT. Our success rate of this treatment was 50%. Thrombectomy and reanastomosis were successful in 2 patients who underwent retransplantation due to PNF. Retransplantation was performed in 14 patients in whom thrombectomy and reanastomosis failed. Eight patients underwent retransplantation as the initial treatment. Three patients could not undergo surgery due to poor clinical condition. One-year and five-year patient survival was 50% and 45% for those who underwent reanastomosis and 67.9% and 54.4% for those who underwent retransplantation, respectively. One-year and five-year graft survival was 24.1%. Conclusion: In patients with the early HAT, early diagnosis, thrombectomy and reanastomosis may be the first treatment of choice to save the patient and the graft. After a failed reanastomosis, retransplantation is the treatment with the best prognosis. Key Words: living donor liver transplantation, hepatic artery reconstruction, hepatic artery thrombosis.
Aim: The aim of this study is to examine our treatment approach, treatment success, factors affecting treatment success, and our results in patients who developed HAT in the early postoperative period (first 7 days) after LDLT in the last 10 years. Material and Method: Medical records of 2545 consecutive liver transplant patients who underwent liver transplantation between January 2013 and May 2023 at Inonu University Liver Transplant Institute were retrospectively reviewed. We excluded 288 patients who underwent cadaveric liver transplantation. In the follow-up of the remaining 2257 patients who underwent LDLT, 64 who patients developed HAT within the first seven days after LDLT were included in the study. Six patients who developed HAT within the first seven days after LDLT but could not undergo successful HAR in the first transplantation operation, because of endothelial dissection in the graft artery were excluded from the study. Demographic characteristics (age, gender), indications for transplantation, recipient artery of hepatic artery reconstruction, intraoperative HAT status, HAT day, radiologic imaging methods used in the diagnosis of HAT, anastomosis between which arteries in revision, number of revisions, revision success, retransplantation status and postoperative biliary complications of the remaining 58 patients were retrospectively analyzed. Results: The incidence of early HAT after LDLT was 2.5% in study group. It was 3.1% in children and 2.4% in adults. The median time to diagnosis of HAT was one day (0-7 days). Thrombectomy and reanastomosis were performed as initial treatment in 46 patients with early HAT. Our success rate of this treatment was 50%. Thrombectomy and reanastomosis were successful in 2 patients who underwent retransplantation due to PNF. Retransplantation was performed in 14 patients in whom thrombectomy and reanastomosis failed. Eight patients underwent retransplantation as the initial treatment. Three patients could not undergo surgery due to poor clinical condition. One-year and five-year patient survival was 50% and 45% for those who underwent reanastomosis and 67.9% and 54.4% for those who underwent retransplantation, respectively. One-year and five-year graft survival was 24.1%. Conclusion: In patients with the early HAT, early diagnosis, thrombectomy and reanastomosis may be the first treatment of choice to save the patient and the graft. After a failed reanastomosis, retransplantation is the treatment with the best prognosis. Key Words: living donor liver transplantation, hepatic artery reconstruction, hepatic artery thrombosis.
Açıklama
Anahtar Kelimeler
Genel Cerrahi, General Surgery
