Akut Yetmezlikte Karaciğer Nakli; Tek Merkez Deneyimi

Akut karaciğer yetmezliği, ilerleyici karaciğer disfonksiyonudur. Karaciğer nakli, etkin bir tedavi seçeneğidir. Bu çalışmanın amacı akut karaciğer yetmezliği nedeniyle yapılan canlı vericili karaciğer nakillerini değerlendirmektir. Nisan 2014 ile Nisan 2019 tarihleri arasında, Medipol Üniversitesi Tıp Fakültesi Hastanesi Organ Nakli Bölümü’nde akut karaciğer yetmezliği nedeniyle canlı vericili karaciğer nakli yapılan 13 hasta retrospektif olarak değerlendirildi. Hastaların yaş ortalaması 21,1±20,9 yıldı. Hastaların dokuzu (%69,2) kadın ve yedisi (%53,8) çocukluk (< 18 yıl) yaş grubunda idi. En sık toksik hepatit nedeniyle (%38,5) karaciğer nakli yapıldı. Hastaların ortalama takip süresi 35,1±12,2 aydı. Hastaların beşinde (%38,5) komplikasyon gelişti. Hastalardan dördünde (%30,7) mortalite görüldü. Genel sağkalım oranı 1 ve 5 yıllık sırasıyla % 84,7 ve % 69,3 idi. Akut yetmezlikte yapılan canlı vericili karaciğer nakillerinin başarılı olduğu görünmektedir.

Anahtar Kelimeler:

Akut karaciğer yetmezliği, karaciğer nakli, analiz

Liver Transplantations in Acute Failure; A Single Center Experiences

Acute hepatic failure is progressive liver dysfunction. Liver transplantation is an effective treatment option. The aim of this study was to evaluate the living donor liver transplantation due to acute liver failure. Between April 2014 and April 2019 at Medipol University Medical Faculty Hospital Organ Transplantation Department, 13 patients with living donor liver transplantations in acute failure was studied retrospectively. The mean age of the patients was 21.1±20,9 years. Of these patients, nine (69.2%) were female and seven (53.8%) were children (< 18 years old) . Liver transplantation was the most common cause of toxic hepatitis (38.5%). The mean follow-up of the period was 35.1±12.2 months. Complications were seen in five patients (38.5%). Mortality was observed in four patients (30.7%). Overall survival rate was 84.7% and 69,3% in 1 and 5 years, respectively. Living donor liver transplantation appears to be successful in acute failure.

Keywords:

Acute liver failure, liver transplantation, analysis,

PDF

___

1.Lee WM, Stravitz RT, Larson AM. Introduction to the revised American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011.Hepatology. 2012; 55:965-967.
2. O’Grady JG. Liver transplantation for acute liver failure. Best Pract Res Clin Gastroenterol. 2012;26: 27–33.
3. Bernal W, Wendon J. Acute liver failure. N Engl J Med 2013; 369: 2525-2534.
4. Krawczyk M, Grąt M, Barski K, Ligocka J, Antczak A, Kornasiewicz O, et al.1000 liver transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw analysis of indications and results. Pol Przegl Chir 2012; 84:304-312.
5. Nyckowski P, Skwarek A, Zieniewicz K, Patkowski W, Alsharabi A, Wróblewski T, et al. Orthotopic liver transplantation for fulminant hepatic failure. Transplant Proc 2006;38:219-220.
6.BhaduriB, Mieli Vergani G.Fulminant hepatic failure: pediatric aspects.Semin Liv Dis .1996;16:349-355.
7.Trey C,Dawidson CS.The management of fulminant hepatic failure.Progress in Liver Diseases.1970;3:282-298.
8.Siddiqui MS, Stravitz RT. Intensive care unit management of patientswith liver failure. Clin Liver Dis. 2014;18:957-978.
9. N. Goldaracena, V. N. Spetzler, M. Marquez, N. Selzner, M. S. Cattral, P. D. Greig, et al. Live Donor Liver Transplantation: A Valid Alternative for Critically Ill Patients SufferingFrom Acute Liver Failure. American Journal of Transplantation 2015; 15: 1591–1597.
10. Trocello JM1, Broussolle E, Girardot-Tinant N, Pelosse M, Lachaux A, Lloyd C,et al . Wilson’s disease, 100 years later. Rev Neurol. 2013;169:936-943.
11.Jo WS, Hossain MA, Park SC. Toxicological profiles of poisonous, edible,andmedicinal mushrooms.Mycobiology 2014;42:215–220.
12. Ferreira R, Romãozinho JM, Amaro P, Ferreira M, Sofia C. Assessment of emergency liver transplantation criteriain acute liver failure due to Amanita phalloides. Eur J Gastroenterol Hepatol 2011;23: 1226–1232.
13. Matsunami H, Makuuchi M, Kawasaki S, Ishizone S, Mizusawa Y, Kawarasaki H, et al. Living-related liver transplantation in fulminant hepatic failure. Lancet. 1992; 340:1411–1412.
14. Bernal W, Cross TJ, Auzinger G, Sizer E, Heneghan MA, Bowles M, et al. Outcome after wait-listing for emergency liver transplantation in acute liver failure: a single centre experience. J Hepatol 2009;50: 306-313.
15. Park SJ, Lim YS, Hwang S, Heo NY, Lee HC, Suh DJ, et al. Emergency adult-to-adult living-donor liver transplantation for acute liver failure in a hepatitis B virusendemic area. Hepatology 2010;51: 903-911.
16. Matsui Y, Sugawara Y, Yamashiki N, Kaneko J, Tamura S, Togashi J, et al. Living donor liver transplantation for fulminant hepatic failure. Hepatol Res 2008;38: 987-996.
17. Ikegami T, Taketomi A, Soejima Y, Yoshizumi T, Sanefuji K, Kayashima H, et al. Living donor liver transplantation for acute liver failure: a 10-year experience in a single center. J Am Coll Surg 2008; 206: 412-418.
18.Yamashiki N, Sugawara Y, Tamura S, Nakayama N, Oketani M, Umeshita K, et al. Outcomes after living donor liver transplantation for acute liver failure in Japan: results of a nationwide survey. Liver Transpl. 2012;9: 1069-1077.
19. Germani G, Theocharidou E, Adam R, Karam V, Wendon J, O'Grady J, et al. Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database. J Hepatol. 2012;57: 288–296
20. Mehrotra S, Mehta N, Rao PS, Lalwani S, Mangla V, Nundy S. Live donor liver transplantation for acute liver failure: A single center experience. Indian J Gastroenterol. 2018;37 : 25-30.