Karaciğer Transplantasyonu Cerrahisinde Postoperatif Mortalite ve Morbiditeye Etki Eden Faktörlerin Retrospektif İncelenmesi
Amaç: Karaciğer nakli, son dönem karaciğer yetmezliğindeki hastalar için tek ve kesin tedaviolarak güncelliğini korumaktadır. Kliniğimizde karaciğer nakli yapılan 28 hastanın mortalite vemorbidite sonuçlarını inceledik.Yöntem: Kliniğimizde Ocak 2018 ve Aralık 2019 tarihleri arasında karaciğer nakli yapılan 28 hastanın verileri retrospektif olarak incelendi ve çalışmaya alındı.Bulgular: Ortotopik karaciğer transplantasyonu (OKN) yapılan hastaların yaş ortalaması51.7±12.7 yıl idi (20-73 yaş aralığı). 28 hastanın 21’i erkek (%75) ve 7’si kadındı (%25). Ortalamaejeksiyon fraksiyonu (EF) %56.9±3.4 olarak saptandı. Ortalama multifactorial end-stage liverdisease (MELD) skoru 22.3±5.3 idi. Bir yıllık takip sonrasında 28 hastadan 8’i hayatını kaybetmişti (%28.6). Ölen 8 hastanın 5’ine 2 ve daha fazla ünite eritrosit süspansiyonu (ES) verilmişti(p=0.044). İki hastaya bir ve daha fazla ünite taze donmuş plazma (TDP) verilmişti (p=0.011).Hastalara ES ve TDP verilmesinin mortaliteyi arttırdığı gözlemlendi. Ölen hastaların ortalamaoperasyon süreleri 12.7±0.9 sa idi. Operasyon süresinin uzamasının mortaliteyi arttırdığı saptandı(p=0.027). Ölen 5 hasta cerrahi komplikasyon nedeniyle ikinci kez ameliyata alınmıştı. Hastalarınikinci kez ameliyata alınmasının mortaliteyi arttırdığı saptandı (p=0.023). Greftlerin canlı donörden veya kadavradan alınmasının mortaliteye etkisinin olmadığı görüldü (p=0.801).Sonuç: Karaciğer nakli yapılan hastalara kan ve kan ürünleri verilmesinin, ikinci kez ameliyataalınmasının ve ameliyat süresinin uzamasının mortaliteyi arttıdığı saptandı.
Retrospective Analysis of Factors Affecting Postoperative Mortality and Morbidity in Liver Transplantation Surgery
Objective: Liver transplantation is still up to date as the only and definitive treatment for patients with end-stage liver failure. We examined the mortality and morbidity results of 28 patients who underwent liver transplantation in our clinic. Method: Data of 28 patients who underwent liver transplantation in our clinic between January 2018 and December 2019 were retrospectively analyzed and included in the study. Results: The mean age of patients who underwent orthotopic liver transplantation (OLT) was 51.7±12.7 years (20-73 years). Of the 28 patients, 21 were male (75%) and 7 were female (25%). The mean ejection fraction (EF) was 56.9±3.4%. The mean model end-stage liver disease (MELD) score was 22.3±5.3. After one year follow-up, 8 of 28 patients died (28.6%). Two or more units of erythrocyte suspension (ES) were given to 5 of 8 patients who died (p=0.044). Two patients received one or more units of fresh frozen plasma (FFP) (p=0.011). It was observed that administration of ES and FFP to patients increased mortality. The mean operation time of the patients who died was 12.7±0.9 hours. It was found that prolonged operation time increased mortality (p=0.027). Five patients who died were operated for the second time due to surgical complications. It was found that second operation of patients increased mortality (p=0.023). It was observed that harvesting the grafts from a living donor or cadaver had no effect on mortality (p=0.801). Conclusion: It was found that giving blood and blood products to patients who underwent liver transplantations, performing a second operation and prolonging the operation time increased mortality.
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