Karaciğer naklinde canlı vericilerle ilgili hayatı tehdit edici komplikasyonlar
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Dosyalar
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Günümüzde, CVKN gelişen cerrahi teknikler ve teknoloji sayesinde güvenle yapılmaktadır. CVKN'de verici güvenliği önceliklidir. Vericilerde hayatı tehdit edici komplikasyonlar (HTEK) sıklığı merkezden merkeze değişmektedir. Bu çalışmada canlı karaciğer vericilerinde HTEK'ların araştırılması amaçlandı. Materyal ve Metod: Eylül 2005 ve Aralık 2014 tarihleri arasında enstitümüzde yapılan 1140 canlı vericili karaciğer nakli için gerçekleştirilen sağ ve sol verici hepatektomi verileri retrospektif olarak incelendi. Clavien sınıflandırmasına göre Grade IIIb ve Grade IV komplikasyonlar HTEK olarak kabul edildi. Vericiler ilk 5 yıl ve son 5 yılda yapılanlar, ilk 100 verici ve sonrasında yapılanlar, sağ ve sol hepatektomi yapılanlar şeklinde gruplara ayrıldı. Gruplar arası gelişen HTEK sıklığını değerlendirmek için Fisher's exact testi kullanıldı ve p<0,05 anlamlı olarak kabul edildi Bulgular: Toplam 1140 vericinin 34 (%2,98) tanesinde HTEK geliştiği görüldü. Bu vericilerin 11'i kadın, 23'ü erkekti ve ortalama yaşları 34,6 (19-62) yıldı. Ortalama VKİ'leri 24,96 kg/m2 (17,8-36,8) idi. HTEK gelişen vericilerin karaciğer remnant volümü %33,81 (%28-%47,8) idi. Sağ hepatektomi 975 (%85,5) vericiye, sol hepatektomi ise 165 (%14,5) vericiye uygulandı. En sık görülen HTEK, safra yolu problemleri idi. İlk 5 yılda yapılan 271 verici hepatektominin 12 (%4,4) tanesinde, son 5 yılda yapılan verici hepatektomilerinin ise 22 (%2,57) tanesinde HTEK gelişti (p>0,05). İlk 100 verici hepatektomilerin 7 (%7) tanesinde, ilk 100 vericiden sonraki 1040 vericinin ise 27 (%2,59) tanesinde HTEK geliştiği görüldü (p=0,02). Ayrıca sağ verici hepatektomi yapılanların 29 (%2,97) tanesinde, sol verici hepatektomilerin ise 5 (%3,03) tanesinde HTEK gelişti (p>0,05). Verici mortalitesi olmadı. Sonuç: CVKN alıcı için hayat kurtarıcı bir ameliyat olsa da tamamen sağlıklı bir verici için morbidite ve mortalite açısından belirgin riskler taşır. Vericide komplikasyon gelişimini tamamen önlemek olası değildir ancak HTEK'ları minimal düzeye indirmek için nakil merkezinin deneyimi önemlidir. Mortaliteyi önlemek için HTEK gelişimine neden olan durumu zamanında saptamak ve uygun şekilde tedavi etmek gereklidir.
INTRODUCTION: Nowadays, LDLT is performed safely through developing surgical techniques and technology. Donor safety is a priority in LDLT. Near-miss events frequency in donors varies from center to center. In this study, we aimed to investigate near miss events of the living liver donors. MATERIAL-METHOD: Between September 2005 and December 2014, 1140 living donors who performed right and left donor hepatectomy, were reviewed retrospectively. Clavien Grade III and Grade IV b complications were considered as near-miss events. Donors were divided into groups. First group is donors who performed in first 5 years and last 5 years, second group is donors who performed first 100 donors and later, third group is who performed right or left hepatectomy. Statistical analysis was performed using Fisher's exact test and p <0.05 was considered significant. RESULTS: Life-threatening complications appeared in 34 of 1140 donor (2.98%). Eleven of them were female, and 23 male. Their mean age and body-mass index were 34,6 year (range from 19 to 62 ) and 24,96 kg/m2 (range from 17,8 to 36,8), respectively. Liver remnant volume of these donor was 33.81% (range from 28 to 47.8%). Right hepatectomy was performed in 975 (85.5%) of the donors and the left hepatectomy was performed in 165 (14.5%) of the donors. The most common near-miss event was biliary problems. Near-miss events were seen in 12 (4.4%) of 271 donor hepatectomy in the first 5 years, 22 (2.57%) of the others in the last 5 years (p> 0.05). Also near-miss events were seen in 7 (7%) of the first 100 donor hepatectomy and in 27 (2.59%) of 1040 that were performed after the first 100 donors (p = 0,02). Near-miss events occurred in 29 (2.97%) of the right donor hepatectomy and 5 (3.03%) of the left donor hepatectomy, respectively. There was no donor mortality. CONCLUSION: Altough LDLT is a life-saving surgery for recipient, it is carried risks of mortality and morbiditiy for completely healty donors. It is not possible to completely prevent the development of complications in the donor, but experience of the transplant center is important to minimalize it. To prevent mortality from Near-miss events, finding the cause and treat appropriately and timely is important.
INTRODUCTION: Nowadays, LDLT is performed safely through developing surgical techniques and technology. Donor safety is a priority in LDLT. Near-miss events frequency in donors varies from center to center. In this study, we aimed to investigate near miss events of the living liver donors. MATERIAL-METHOD: Between September 2005 and December 2014, 1140 living donors who performed right and left donor hepatectomy, were reviewed retrospectively. Clavien Grade III and Grade IV b complications were considered as near-miss events. Donors were divided into groups. First group is donors who performed in first 5 years and last 5 years, second group is donors who performed first 100 donors and later, third group is who performed right or left hepatectomy. Statistical analysis was performed using Fisher's exact test and p <0.05 was considered significant. RESULTS: Life-threatening complications appeared in 34 of 1140 donor (2.98%). Eleven of them were female, and 23 male. Their mean age and body-mass index were 34,6 year (range from 19 to 62 ) and 24,96 kg/m2 (range from 17,8 to 36,8), respectively. Liver remnant volume of these donor was 33.81% (range from 28 to 47.8%). Right hepatectomy was performed in 975 (85.5%) of the donors and the left hepatectomy was performed in 165 (14.5%) of the donors. The most common near-miss event was biliary problems. Near-miss events were seen in 12 (4.4%) of 271 donor hepatectomy in the first 5 years, 22 (2.57%) of the others in the last 5 years (p> 0.05). Also near-miss events were seen in 7 (7%) of the first 100 donor hepatectomy and in 27 (2.59%) of 1040 that were performed after the first 100 donors (p = 0,02). Near-miss events occurred in 29 (2.97%) of the right donor hepatectomy and 5 (3.03%) of the left donor hepatectomy, respectively. There was no donor mortality. CONCLUSION: Altough LDLT is a life-saving surgery for recipient, it is carried risks of mortality and morbiditiy for completely healty donors. It is not possible to completely prevent the development of complications in the donor, but experience of the transplant center is important to minimalize it. To prevent mortality from Near-miss events, finding the cause and treat appropriately and timely is important.
Açıklama
Anahtar Kelimeler
General Surgery, Genel Cerrahi
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Onur, A. (2015). Karaciğer naklinde canlı vericilerle ilgili hayatı tehdit edici komplikasyonlar. Yayımlanmış uzmanlık tezi, İnönü Üniversitesi, Malatya.
