Anil AYSAL, Cihan AGALAR, Çiğdem ARSLAN, Tufan EGELİ, Mücahit ÖZBİLGİN, Tarkan UNEK, İbrahim ASTARCIOĞLU, Özgül SAĞOL

Karaciğer naklinde postperfüzyon karaciğer biyopsilerindeki morfolojik bulgularin prognostik değeri

Amaç: Bu çalışmada, perfüzyon sonrası karaciğer biyopsileri değerlendirilerek morfolojik bulguların greft fonksiyonu, rejeksiyon durumu ve sağkalım üzerindeki potansiyel prognostik etkilerinin gösterilmesi amaçlanmıştır. Gereç ve Yöntem: 2006-2010 yılları arasında kadavradan karaciğer nakli yapılan 66 olgu çalışmaya dahil edildi. Postperfüzyon kama biyopsilerine ait kesitler, intrasinüzoidal nötrofilik infiltrasyon, mikroveziküler steatoz, hepatosit şişmesi, hepatoselüler nekroz, endotelyal şişme, safra kanalı epitel değişiklikleri, kolanjiyolar proliferasyon ve sinüzoidal konjesyon/hemoraji açısından değerlendirildi. Histopatolojik özellikler ile erken allogreft disfonksiyonu, mortalite oranı ve rejeksiyon durumu arasındaki ilişkiler istatistiksel olarak analiz edildi. Bulgular: İntrasinüzoidal nötrofilik infiltrasyon 40 olguda (%60) derece 1, 24 olguda (%36) derece 2 ve 2 olguda (%4) derece 3 idi. Derece 2-3 intrasinüzoidal nötrofil varlığının mortalite oranı ile, sinüzoidal konjesyon/kanama varlığının rejeksiyon ile istatistiksel olarak anlamlı şekilde ilişkili olduğu saptandı. Ayrıca sinüzoidal konjesyon/hemoraji varlığının, daha kısa sağkalım süresi ile istatistiksel olarak anlamlı şekilde ilişkili olduğu bulundu. Sonuç: İntrasinüzoidal nötrofilik infiltrasyon, mortaliteyi öngörmek için olası bir histopatolojik belirleyici olma umudu taşımaktadır. Ayrıca çalışmamıza göre sinüzoidal konjesyon varlığı hem rejeksiyon hem de sağkalım için prognostik faktör olarak aday olabilir.

Anahtar Kelimeler:

Karaciğer nakli, perfüzyon sonrası biyopsi, greft disfonksiyonu, prognoz

Prognostic value of the morphological features of postperfusion liver biopsies in liver transplantation

Purpose: The aim of this study was to show the potential prognostic effects of morphological findings for the graft function, rejection and survival by evaluating the postperfusion liver biopsies. Materials and Methods: Sixty six cases who underwent cadaveric liver transplantation between 2006-2010 were included. The representative slides of postperfusion subcapsular wedge biopsies were evaluated for intrasinusoidal neutrophilic infiltration, microvesicular steatosis, hepatocyte swelling, hepatocellular necrosis, endothelial swelling, bile duct epithelial changes, cholangiolar proliferation and sinusoidal congestion/hemorrhage. The associations between the histopathological features and early allograft dysfunction, mortality rate and rejection status were statistically analysed. Results: Intrasinusoidal neutrophilic infiltration was grade 1 in 40 (60%), grade 2 in 24 (36%), and grade 3 in 2 cases (4%). The presence of grade 2-3 intrasinusoidal neutrophils was found to be significantly associated with mortality rate. The presence of sinusiodal congestion/hemorrhage was statistically related to the rejection. The presence of sinusiodal congestion/hemorrhage was significantly associated with shorter overall survival. Conclusion: Intrasinusoidal neutrophilic infiltration is promising to be a possible histopathological predictor for mortality. In addition, the presence of sinusoidal congestion can be a candidate as a prognostic factor both for rejection and overall survival based on our study.

Keywords:

Liver transplantation, postperfusion biopsy, graft dysfunction, prognosis,

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