Öz
Amaç: Karaciğer transplantasyonu için kullanılan greftin çeşitli nedenlerle fonksiyon kaybı re-transplantasyonu gerektirmektedir. Bu çalışmada merkezimizde gerçekleştirilen tüm karaciğer re-transplantasyon olguları değerlendirilmiştir.
Gereç ve Yöntem: Kliniğimizde erken ve geç dönem olmak üzere karaciğer re-transplantasyonu yapılan tüm hastalar çalışmaya dahil edildi. Demografik bilgiler, ameliyatla ilgili detaylar ve komplikasyonlar retrospektif olarak değerlendirilmiştir.
Bulgular: 2018'den 2023'e kadar kurumumuzda 228 alıcıya 236 karaciğer nakli gerçekleştirildi. Bu hastalardan 10'u dış merkezlerden olmak üzere toplam 18 hastaya re-transplantasyon yapılmıştır. Bu hastaların 12'si erkek, 6'sı kadın olup, yaş ortalaması pediatrik hastalarda 6,7 (±4,8), erişkin hastalarda ise 49 (±14,32) idi; çocuk hastaların ortalama ağırlığı 19,76 kg (±8,86), yetişkin hastaların ortalama ağırlığı 70,48 kg (±11,83); çocuk hastaların ortalama vücut kitle indeksi 17,41 kg/m² (±2,84), yetişkin hastaların ise 22,33 kg/m² (±2,65) olduğu belirlendi. Bu hastaların altısına erken retransplantasyon (7,6±5,4 gün), 12'sine geç retransplantasyon (7,6±5,3 yıl) uygulandı. Re-transplantasyon etiyolojisi açısından erken dönemde primer non-fonksiyon ön plana çıkarken, geç dönemde sekonder biliyer siroz, hastalık nüksü ve kronik rejeksiyon saptandı. Perioperatif dönemde yedi alıcı (%39) öldü ve bu hasta grubunda 1 yıllık sağkalım %61 olarak hesaplandı.
Sonuç: Re-transplantasyon yüksek mortalite ve morbidite oranlarına sahiptir. Erken re-transplantasyon, özellikle primer non-fonksiyon vakalarında yüksek ölüm oranlarının üstesinden geliyor gibi görünse de, kadavra organ eksikliği ve canlı donör ihtiyacı önemli sorunlardır.
Anahtar Kelimeler
Karaciğer nakli kronik greft disfonksiyonu karaciğer re-transplantasyonu
Kaynakça
- Polak WG, Peeters PMJG, Slooff MJH. The evolution of surgical techniques in clinical liver transplantation. A review. Clinical Transplantation 2009;23(4):546-64. [CrossRef] google scholar
- Adam R, McMaster P, O’Grady JG, et al. Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry. Liver Transpl 2003;9(12):1231-43. [CrossRef] google scholar
- Craig EV, Heller MT. Complications of liver transplant. Abdom Radiol (NY) 2021;46(1):43-67. [CrossRef] google scholar
- Zampachovâ V, Honsovâ E. Rekurence primarnıch chorob po transplantaci jater [Recurrence of primary diseases after liver transplantation]. Cesk Patol 2015;51(4):170-4. google scholar
- Lim N, Lake J. Recurrent disease after liver transplantation. Curr Hepatology Rep 2020;19:54-62. [CrossRef] google scholar
- Kashyap R, Jain A, Reyes J, Demetris AJ, Elmagd KA, Dodson SF, et al. Causes of retransplantation after primary liver transplantation in 4000 consecutive patients: 2 to 19 years follow up. Transplant Proc 2001;33(1-2):1486-7. [CrossRef] google scholar
- Yoon PD, Patel MS, Murillo Perez CF, Ivanics T, Claasen MPAW, Muaddi H, et al. Outcomes of adult liver retransplantation: A Canadian National Database Analysis. Can J Gastroenterol Hepatol 2022:2022:9932631. [CrossRef] google scholar
- Jeffrey AW, Jeffrey GP, Stormon M, Thomas G, O’Loughlin E, Shun A, et al. Outcomes for children after second liver transplantations are similar to those after first transplantations: a binational registry analysis. Med J Aust 2020:213(10):464-70. [CrossRef] google scholar
- Marudanayagam R, Shanmugam V, Sandhu B, Gunson BK, Mirza DF, Mayer D, et al. Liver retransplantation in adults: a single-centre, 25-year experience. HPB (Oxford) 2010;12(3):217-24. [CrossRef] google scholar
- Pardo F, Pons JA, Castells L, Colmenero J, Gomez MÂ, Llado L, et al. VI consensus document by the Spanish Liver Transplantation Society. [VI documento de consenso de la sociedad espanola de trasplante hepâtico (SETH)] Gastroenterol Hepatol 2018:41(6):406-21. [CrossRef] google scholar
- Alim A, Tirnova İ, Karataş C, Akbulut A, Demir B, Kanmaz T. Liver transplantation for congenital metabolic disorders. Cerrahpaşa Med J 2022;46(1):21-5. google scholar
- Takagi K, Domagala P, Porte RJ, Alwayn I, Metselaar HJ, van den Berg AP, et al. Liver retransplantation in adult recipients: analysis of a 38-year experience in the Netherlands. J Hepatobiliary Pancreat Sci 2020;27(1):26-33. [CrossRef] google scholar
- Azoulay D, Linhares MM, Huguet E, Delvart V, Castaing D, Adam R, et al. Decision for retransplantation of the liver: an experience- and cost-based analysis. Ann Surg 2002:236(6):713-21. [CrossRef] google scholar
- Adani GL, Baccarani U, Risaliti A, Sainz-Barriga M, Lorenzin D, Costa G, et al. A single-center experience of late retransplantation of the liver. Transplant Proc 2005;37(6):2599-600. [CrossRef] google scholar
- Uemura T, Randall HB, Sanchez EQ, Ikegami T, Narasimhan G, McKenna GJ, et al. Liver retransplantation for primary nonfunction: analysis of a 20-year single-center experience. Liver Transpl 2007;13(2):227-33. [CrossRef] google scholar
- Yan JQ, Peng CH, Li HW, Shen BY, Zhou GW, Yang WP, et al. Preliminary clinical experience in liver retransplantation. Hepatobiliary Pancreat Dis Int 2007;6(2):152-6. google scholar
- Onaca N, Levy MF, Ueno T, Martin AP, Sanchez EQ, Chinnakotla S, et al. An outcome comparison between primary liver transplantation and retransplantation based on the pretransplant MELD score. Transpl Int 2006;19(4):282-7. [CrossRef] google scholar
- Aktas H, Emiroglu R. A rising necessity: Liver retransplantation: A single center experience. Ann Med Res 2021;28(5):1019-23. [CrossRef] google scholar
- Moon HH, Kim TS, Song S, Shin M, Chung YJ, Lee S, et al. Early vs late liver retransplantation: Different characteristics and prognostic factors. Transplant Proc 2018;50(9):2668-74. [CrossRef] google scholar
- Arora H, Thekkekandam J, Tesche L, Sweeting R, Gerber DA, Hayashi PH, et al. Long-term survival after 67 hours of anhepatic state due to primary liver allograft nonfunction. Liver Transpl 2010;16(12):1428-33. [CrossRef] google scholar
- Singh N, Washburn K, Schenk A, Hill B, Hardy T, Black S, et al. Rescue hepatectomy and anhepatic phase management after primary nonfunction in a liver transplant. Exp Clin Transplant 2022;20(8):776-9. [CrossRef] google scholar
- Turkish Ministry of Health, General Directorate of Health Services, Department of Tissue, Organ Transplantation and Dialysis Services (2022). https://organkds.saglik.gov.tr/dss/ PUBLIC/Brain_Death.aspx google scholar
Öz
Objective: Function loss, for whatever reason, of the graft used for liver transplantation requires re-transplantation. This study is an evaluation of all re-transplantations performed at our center.
Material and Method: All liver re-transplantation patients whose surgeries had been performed at our clinic, whether at an early or late stage, were included in the study. Demographic in formation, details related to the surgery, and complications were evaluated retrospectively.
Result: From 2018 to 2023, 236 liver transplantations were performed on 228 recipients in our institution. Of these patients, a total of 18 underwent re-transplantation, 10 of whom were from external centers and 8 of whom had had their first liver transplantation performed at our center. Of these patients, 12 were male and 6 were female, with a mean age of 6.7 years (±4.8) for pediatric patients and 49 years (±14.32) for adult patients. The mean weight for pediatric patients was 19.76 kg (±8.86), and for adult patients it was 70.48 kg (±11.83). The mean body mass index for pediatric patients was 17.41 kg/m² (±2.84), and for adult patients it was 22.33 kg/m² (±2.65). Six of these patients underwent early re-transplantation (7.6±5.4 days) and 12 underwent late re-transplantation (7.6±5.3 years). In terms of re-transplantation etiology, primary non-function was prominent for the early period, while secondary biliary cirrhosis, disease recurrence, and chronic rejection were detected for the late period. Seven recipients (39%) died during the perioperative period, and 1-year survival was calculated as 61% in this patient group.
Conclusion: Re-transplantation has high mortality and morbidity rates. Although early re-transplantation seems to overcome high mortality rates, especially in primary non-function cases, organ shortage and the need for living donors are significant problems.
Anahtar Kelimeler
Liver transplantation chronic graft dysfunction liver re-transplantation
Kaynakça
- Polak WG, Peeters PMJG, Slooff MJH. The evolution of surgical techniques in clinical liver transplantation. A review. Clinical Transplantation 2009;23(4):546-64. [CrossRef] google scholar
- Adam R, McMaster P, O’Grady JG, et al. Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry. Liver Transpl 2003;9(12):1231-43. [CrossRef] google scholar
- Craig EV, Heller MT. Complications of liver transplant. Abdom Radiol (NY) 2021;46(1):43-67. [CrossRef] google scholar
- Zampachovâ V, Honsovâ E. Rekurence primarnıch chorob po transplantaci jater [Recurrence of primary diseases after liver transplantation]. Cesk Patol 2015;51(4):170-4. google scholar
- Lim N, Lake J. Recurrent disease after liver transplantation. Curr Hepatology Rep 2020;19:54-62. [CrossRef] google scholar
- Kashyap R, Jain A, Reyes J, Demetris AJ, Elmagd KA, Dodson SF, et al. Causes of retransplantation after primary liver transplantation in 4000 consecutive patients: 2 to 19 years follow up. Transplant Proc 2001;33(1-2):1486-7. [CrossRef] google scholar
- Yoon PD, Patel MS, Murillo Perez CF, Ivanics T, Claasen MPAW, Muaddi H, et al. Outcomes of adult liver retransplantation: A Canadian National Database Analysis. Can J Gastroenterol Hepatol 2022:2022:9932631. [CrossRef] google scholar
- Jeffrey AW, Jeffrey GP, Stormon M, Thomas G, O’Loughlin E, Shun A, et al. Outcomes for children after second liver transplantations are similar to those after first transplantations: a binational registry analysis. Med J Aust 2020:213(10):464-70. [CrossRef] google scholar
- Marudanayagam R, Shanmugam V, Sandhu B, Gunson BK, Mirza DF, Mayer D, et al. Liver retransplantation in adults: a single-centre, 25-year experience. HPB (Oxford) 2010;12(3):217-24. [CrossRef] google scholar
- Pardo F, Pons JA, Castells L, Colmenero J, Gomez MÂ, Llado L, et al. VI consensus document by the Spanish Liver Transplantation Society. [VI documento de consenso de la sociedad espanola de trasplante hepâtico (SETH)] Gastroenterol Hepatol 2018:41(6):406-21. [CrossRef] google scholar
- Alim A, Tirnova İ, Karataş C, Akbulut A, Demir B, Kanmaz T. Liver transplantation for congenital metabolic disorders. Cerrahpaşa Med J 2022;46(1):21-5. google scholar
- Takagi K, Domagala P, Porte RJ, Alwayn I, Metselaar HJ, van den Berg AP, et al. Liver retransplantation in adult recipients: analysis of a 38-year experience in the Netherlands. J Hepatobiliary Pancreat Sci 2020;27(1):26-33. [CrossRef] google scholar
- Azoulay D, Linhares MM, Huguet E, Delvart V, Castaing D, Adam R, et al. Decision for retransplantation of the liver: an experience- and cost-based analysis. Ann Surg 2002:236(6):713-21. [CrossRef] google scholar
- Adani GL, Baccarani U, Risaliti A, Sainz-Barriga M, Lorenzin D, Costa G, et al. A single-center experience of late retransplantation of the liver. Transplant Proc 2005;37(6):2599-600. [CrossRef] google scholar
- Uemura T, Randall HB, Sanchez EQ, Ikegami T, Narasimhan G, McKenna GJ, et al. Liver retransplantation for primary nonfunction: analysis of a 20-year single-center experience. Liver Transpl 2007;13(2):227-33. [CrossRef] google scholar
- Yan JQ, Peng CH, Li HW, Shen BY, Zhou GW, Yang WP, et al. Preliminary clinical experience in liver retransplantation. Hepatobiliary Pancreat Dis Int 2007;6(2):152-6. google scholar
- Onaca N, Levy MF, Ueno T, Martin AP, Sanchez EQ, Chinnakotla S, et al. An outcome comparison between primary liver transplantation and retransplantation based on the pretransplant MELD score. Transpl Int 2006;19(4):282-7. [CrossRef] google scholar
- Aktas H, Emiroglu R. A rising necessity: Liver retransplantation: A single center experience. Ann Med Res 2021;28(5):1019-23. [CrossRef] google scholar
- Moon HH, Kim TS, Song S, Shin M, Chung YJ, Lee S, et al. Early vs late liver retransplantation: Different characteristics and prognostic factors. Transplant Proc 2018;50(9):2668-74. [CrossRef] google scholar
- Arora H, Thekkekandam J, Tesche L, Sweeting R, Gerber DA, Hayashi PH, et al. Long-term survival after 67 hours of anhepatic state due to primary liver allograft nonfunction. Liver Transpl 2010;16(12):1428-33. [CrossRef] google scholar
- Singh N, Washburn K, Schenk A, Hill B, Hardy T, Black S, et al. Rescue hepatectomy and anhepatic phase management after primary nonfunction in a liver transplant. Exp Clin Transplant 2022;20(8):776-9. [CrossRef] google scholar
- Turkish Ministry of Health, General Directorate of Health Services, Department of Tissue, Organ Transplantation and Dialysis Services (2022). https://organkds.saglik.gov.tr/dss/ PUBLIC/Brain_Death.aspx google scholar
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Hizmetleri ve Sistemleri (Diğer) |
| Bölüm | ARAŞTIRMA |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Ocak 2024 |
| Gönderilme Tarihi | 17 Mayıs 2023 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 87 Sayı: 1 |
Kaynak Göster
Contact information and address
Addressi: İ.Ü. İstanbul Tıp Fakültesi Dekanlığı, Turgut Özal Cad. 34093 Çapa, Fatih, İstanbul, TÜRKİYE
Email: itfdergisi@istanbul.edu.tr
Phone: +90 212 414 21 61