Canlı Vericili Karaciğer Naklinden Sonra Gelişen Hepatik Venöz Çıkım Darlığı
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Dosyalar
Tarih
2014
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Canlı vericili karaciğer nakli (CVKN) sonrası görülen önemli komplikasyonlardan biri hepatik venöz çıkım darlığı (HVÇD)'dır. HVÇD gelişme riskini minimize etmek için çeşitli venöz rekonstruksiyon modelleri geliştirilmiştir. Teknik gelişmelere rağmen HVÇD gelişen olgulara ne zaman ve nasıl yaklaşılması gerektiği konusundaki karmaşa hala devam etmektedir. Bu çalışmada CVKN sonrası HVÇD gelişen olgulara yaklaşımımızı paylaşmayı amaçladık. GEREÇ ve YÖNTEM: Kasım 2007 ile Nisan 2014 tarihleri arasında İnönü Üniversitesi tıp Fakültesi Genel Cerrahi Anabilim Dalında CVKN yapılan 1011 hastanın dosyaları retrospektif olarak incelendi. Nakil sonrası HVÇD gelişen 35 hastanın demografik, klinik ve radyolojik verileri retrospektif olarak değerlendirildi. Altta yatan sebepler gözönünde bulundurularak nakil sonrası ilk 30 gün içinde gelişen venöz darlıklar erken dönem HVÇD, 30. günden sonra ortaya çıkan darlıklar ise geç dönem HVÇD'ı olarak tanımlandı. HVÇD'nın tanısında karaciğer fonksiyon testleri, Doppler ultrasonografi ve dinamik bilgisayarlı tomografiden yararlanıldı. Ayrıca konvansiyonel venografi ile hem HVÇD tanısı doğrulandı hemde gerekli girişimsel tedavi yapıldı. BULGULAR: Yaşları 1 ile 61 yıl arasında değişen (32.5±20.3 yıl) 22'si erkek ve 13'ü kadın olmak üzere toplam 35 (%3.46) hasta çalışmaya dahil edildi. Hastaların 24'ü erişkin [yaş: 18-61 (44.1) yıl, MELD Skoru: 8-50 (19.3) GWRW: %1.1 (% 0.8-1.9)] ve 11'i pediatrik [yaş: 1-17 (8.0) yıl, PELD Skoru: 2-41 (22.4) GWRW: %1.6 (% 0.78-3)] yaş grubundandı. Hastalarda karaciğer naklinden ortalama 205.7±264 gün (aralık: 14 – 1440 gün) sonra HVÇD ile uyumlu bulgular gelişti. Hastaların 8'inde post-transplant erken dönemde (≤30 gün) HVÇD gelişirken 27 hastada ise geç dönemde (>30 gün) HVÇD gelişti. Hastalara ortalama 1.5 ± 1.1 (aralık:1-6) kez balon anjioplasti yapıldı. Balon anjioplasti yapılan 4 hastaya (2 erişkin, 2 pediatrik) aynı seansta genişleyebilir stent yerleştirildi. Anjioplasti sonrası 51 ile 2310 günlük takip sürecinde 24 (%68.6) hastada HVÇD ile ilgili belirtiler tamamen gerilerken 11 (%31.4) hastada HVÇD ile klinik tabloda düzelme olmadı. Klinik t ablosu düzelmeyen hastaların 9'u greft yetmezliğinden, 2'si retransplantasyondan sonra kaybedildi. Özetle post-transplant erken dönemde HVÇD gelişen olguların % 62,5'inde mortalite gelişirken post-transplant geç dönemde HVÇD gelişen olguların ise % 22,2'sinde mortalite gelişti. SONUÇ: CVKN sonrası HVÇD oranlarımız (%3.46) literatürde yayınlanan oranlardan daha düşüktür. Bu durum hepatik venöz drenaj için kullandığımız geniş ağızlı venöz anastomoz modeli ile yakından ilişkilidir. HVÇD gelişen olgulara yaklaşımda öncelik anjiografik tanı araçlarına verilmelidir. Anahtar Kelimeler: Karaciğer nakli, Venöz rekonstrüksiyon, Hepatik venöz çıkım darlığı, Balon anjioplasti
AIM: Hepatic venous outflow stenosis (HVOS) is one of the major complication after living donor liver transplantation (LDLT). Various venous reconstruction models have been developed to minimize HVOS risk. Despite technical advances, the mess when and how HVOS cases should be approached, is still going on.In this study, we aimed to share our approach to patients who developed HVOSafter LDLT. MATERIAL AND METHOD: Between November 2007 and April 2014, 1011 patients who have been performed LDLT, were analyzed retrospectively at Inonu University Medical Faculty, Department of General Surgery. Demographic, clinical and radiographic data of the 35 patients who developed post-transplant HVOS, were retrospectively evaluated.By considering the underlying cause of venous stenosis, stenosis was defined as early HVOS in the first 30 days and occurring after 30 days post-transplant was defined as the late period. In the diagnosis of HVOSwas used liver function tests, Doppler ultrasonography and dynamic computed tomography.In addition, both diagnosis and necessary interventional treatment of HVOS was performed with venography. FINDINGS: Total35 (3.46%) patients who were ages range from 1 to 61 years (32.5 ± 20.3 years), 22 males and 13 females were included in the study.The number of adult age group patients was 24[age: 18-61 (44.1) years, MELD Score: 8-50 (19.3) GWRW: 1.1% (0.8-1.9%)] and 11 was pediatric [age: 1-17 (8.0) year, PELD Score: 2-41 (22.4) GWRW: 1.6% (0.78-3%)]. The period that was developed symptoms consistent with the HVOS was an average 205.7 ± 264 days (range 14-1440 days) after transplantation. The number of patients who developed HVOSin the post-transplant late period (> 30 days) was 27, and 8 patients was in the early post-transplant period (≤30 days). Balloon angioplasty was performed a mean of 1.5 ± 1.1 (range: 1-6) times for each patient. In 4 patients (2 adults, 2 pediatric),expandable stents were placed in the same session with balloon angioplasty. In 51-2310day follow-up period after angioplasty, 24 (68.6%) patients who had symptoms related HVOS completely regressed , 11 (31.4%) patients did not improve.9 of the patients who did not improve the clinical status, diedwith graft failure, and 2 of them died after retransplantation. In short of, mortality in the patients who developed HVOS in the late period, was 22.2% and mortality in the patients who developed HVOS in early period was 62.5%. CONCLUSION: After LDLT, our HVOS rate (3.46%) is lower than the rate reported in the literature.The reason why such a small amount is observed in our cases, we used venous anastomosis model that had been with a broad rim during transplantation. In the management of patients who developed HVOS, the priority should be given to angiographic diagnostic tools. Key words; Liver transplantation, venous reconstruction, hepatic venous outflow obstruction;,ballon angioplasty
AIM: Hepatic venous outflow stenosis (HVOS) is one of the major complication after living donor liver transplantation (LDLT). Various venous reconstruction models have been developed to minimize HVOS risk. Despite technical advances, the mess when and how HVOS cases should be approached, is still going on.In this study, we aimed to share our approach to patients who developed HVOSafter LDLT. MATERIAL AND METHOD: Between November 2007 and April 2014, 1011 patients who have been performed LDLT, were analyzed retrospectively at Inonu University Medical Faculty, Department of General Surgery. Demographic, clinical and radiographic data of the 35 patients who developed post-transplant HVOS, were retrospectively evaluated.By considering the underlying cause of venous stenosis, stenosis was defined as early HVOS in the first 30 days and occurring after 30 days post-transplant was defined as the late period. In the diagnosis of HVOSwas used liver function tests, Doppler ultrasonography and dynamic computed tomography.In addition, both diagnosis and necessary interventional treatment of HVOS was performed with venography. FINDINGS: Total35 (3.46%) patients who were ages range from 1 to 61 years (32.5 ± 20.3 years), 22 males and 13 females were included in the study.The number of adult age group patients was 24[age: 18-61 (44.1) years, MELD Score: 8-50 (19.3) GWRW: 1.1% (0.8-1.9%)] and 11 was pediatric [age: 1-17 (8.0) year, PELD Score: 2-41 (22.4) GWRW: 1.6% (0.78-3%)]. The period that was developed symptoms consistent with the HVOS was an average 205.7 ± 264 days (range 14-1440 days) after transplantation. The number of patients who developed HVOSin the post-transplant late period (> 30 days) was 27, and 8 patients was in the early post-transplant period (≤30 days). Balloon angioplasty was performed a mean of 1.5 ± 1.1 (range: 1-6) times for each patient. In 4 patients (2 adults, 2 pediatric),expandable stents were placed in the same session with balloon angioplasty. In 51-2310day follow-up period after angioplasty, 24 (68.6%) patients who had symptoms related HVOS completely regressed , 11 (31.4%) patients did not improve.9 of the patients who did not improve the clinical status, diedwith graft failure, and 2 of them died after retransplantation. In short of, mortality in the patients who developed HVOS in the late period, was 22.2% and mortality in the patients who developed HVOS in early period was 62.5%. CONCLUSION: After LDLT, our HVOS rate (3.46%) is lower than the rate reported in the literature.The reason why such a small amount is observed in our cases, we used venous anastomosis model that had been with a broad rim during transplantation. In the management of patients who developed HVOS, the priority should be given to angiographic diagnostic tools. Key words; Liver transplantation, venous reconstruction, hepatic venous outflow obstruction;,ballon angioplasty
Açıklama
Anahtar Kelimeler
Genel Cerrahi, General Surgery
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Koç, S. (2014). Canlı Vericili Karaciğer Naklinden Sonra Gelişen Hepatik Venöz Çıkım Darlığı. Yayımlanmış uzmanlık tezi, İnönü Üniversitesi, Malatya.
