Canlı vericili sağ lob karaciğer naklinde portal ven varyasyonları ve trombüsleri

Amaç: Son dönem karaciğer hastalığının kesin tek tedavi yöntemi karaciğer naklidir. Kadavra karaciğer naklinin sınırlı olduğu ülkelerde, canlı donör karaciğer nakli yapılır. Bununla birlikte, donörün portal veninde bir varyasyonun veya alıcının portal veninde bir trombüsün varlığı özel bir dikkat gerektirir. Bu çalışmada, canlı vericili karaciğer nakli için bu potansiyel sınırlamaların her ikisi de değerlendirildi.Yöntemler: Retrospektif kohort çalışma planlandı. Nisan 2014 - Aralık 2017 tarihleri arasında Medipol Üniversitesi Tıp Fakültesi, Organ Nakli Merkezi'nde sağ lob canlı vericili karaciğer nakli yapılan 129 hastayı retrospektif olarak değerlendirdik.Bulgular: Hastaların dokuzuna (%7) portal ven varyasyonu veya portal ven trombüsünden dolayı portal venöz rekonstrüksiyon uygulandı. Altı hastada (%67) sağ lob greftinde çift portal ven açıklığının olması nedeniyle rekonstrüksiyon yapıldı. Üç hastada (%33) portal vende trombüs nedeniyle rekonstrüksiyon yapıldı. Bir hastada (%11,1) ameliyat sonrası morbidite ve bir hastada (%11,1) mortalite görüldü.Sonuç: Bu çalışmada, dondurulmuş iliak ven greftlerinin portal ven rekonstrüksiyonları için güvenli bir şekilde kullanılabileceği saptanmıştır.

Anahtar Kelimeler:

Canlı vericili sağ lob karaciğer nakli, Portal ven varyasyonu, Portal ven trombüsü, Portal ven rekonstrüksiyonu

Portal vein variation and thrombosis in right lobe living donor liver transplantation

Aim: The only definitive treatment of end stage liver disease is liver transplantation. In countries where cadaveric liver transplants are limited, living donor liver transplantation is performed. However, the presence of a variation in the portal vein of the donor, or a thrombus in the portal vein of the recipient, requires specific consideration. In this study, both of these potential limitations to living donor liver transplantation were evaluated.Patients: We designed a retrospective cohort study. From April 2014 to December 2017 we retrospectively evaluated 129 patients who underwent right lobe living donor liver transplantation in Organ Transplantation Center, Medipol University Faculty of Medicine, Istanbul, Turkey.Results: Nine (7%) of the patients underwent portal venous reconstruction due to either portal vein variation or portal vein thrombosis. In six patients (67%) reconstruction was performed due to the presence of a double PV in the right lobe graft. In three (33%) patients, a thrombus in the PV necessitated a reconstruction. Early postoperative morbidity occurred in one patient (11.1%) and mortality in one patient (11.1%).Conclusions: In this study, we found portal vein reconstructions using safely frozen iliac vein grafts.

Keywords:

Right lobe living donor liver transplantation, Portal vein variation, Portal vein reconstruction, Portal vein thrombosis,

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