MÜCAHİT ÖZBİLGİN, TUFAN EGELİ, TARKAN ÜNEK, CİHAN AĞALAR, Alikadir DEĞİRMENCİ, İbrahim ASTARCIOĞLU, Sevda ÖZKARDEŞLER, Özgül SAĞOL, HÜLYA ELLİDOKUZ

Yükselmi̇ş Kan Eozi̇nofi̇l Sayısı Canlı Veri̇ci̇li̇ Karaci̇ğer Transplantasyonu Sonrası Geç Ortaya Çıkan Akut Rejeksi̇yonun (GOAR) Tahmi̇ni̇nde Önemli̇ Bi̇r Beli̇rteç Olabilir mi ?

Amaç: Canlı vericili karaciğer nakillerinde(CVKN) 6.aydan sonra ortaya çıkanrejeksiyonlar “geç akut rejeksiyon” (GOAR) olarak tanımlanmaktadır. Geçakut rejeksiyonun tanısında karaciğer biyopsisi hala altın standarttır. Ancakkaraciğer biyopsisinin komplikasyonları ve morbiditesi düşünüldüğünde, karaciğerbiyopsisi yerine daha az noninvaziv bir yöntem olan artmış kan eozinofilsayısı prediktif bir biomarker olarak kullanılabilir mi? Yöntem ve Metod:Araştırmamızda Dokuz Eylül Üniversitesi Tıp Fakültesi Genel Cerrahi KaraciğerNakli Biriminde Haziran 2000- 2017 yıllarında CVKN yapılan, 18 yaşındanbüyük ve en az 6 ay sağkalımı olan hastalar çalışmaya dahil edilmiştir.GOAR gelişen hastaların; demografik verileri, soğuk iskemi süreleri, Child veMELD skorları, GOAR gelişmeden önceki immünsüpresif ajanların dozları,kan düzeyleri ve komorbiditeleri incelendi. GOAR’dan şüphelenilen olgularınbiyopsi sonuçları ve biyopsi öncesi kan laboratuvar değerleri retrospektifolarak tarandı. Yükselmiş kan eozinofil düzeylerinin GOAR gelişimi üzerineetkileri araştırıldı. Bulgular: Çalışmada CVKN uygulanmış 240 hastadan, izlemsüresince karaciğer enzimlerinde yükselme nedeniyle karaciğer biyopsisiyapılan 65(%27) hasta incelendi. Olguların 28(%43)’inde GOAR tespitedilirken, 37(%57)’sinde herhangi bir rejeksiyona rastlanmadı. Biyopsi sonuçlarıBanff patoloji skorlamasına göre; 10(%35.7)’u hafif,13(%46.4)’ü orta ve5(%17.9)’i şiddetli rejeksiyonlardı. Hastaların 21(75%)’i erkek, 7(25%)’si kadındı.Ortalama izlem süresi 3056(184-4877) gündü. Biyopsi yapılma zamanıortalama postoperatif 660’ıncı(180-4354) gündü. Yükselmiş kan eozinofil değeriile GOAR gelişimi arasında istatistiksel olarak anlamlı bir ilişki saptandı(p

Can Elevated Serum Eosinophil Count Be Used As A Predictive Marker For Diagnosis Of “Late Acute Rejection” In Living Donor Liver Transplants?

Object: Rejections observed in live donor liver transplants (LDLT) after the 6th month are defined as “late acute rejection” (LAR). Liver biopsy is still the gold standard for diagnosis of these cases. However, considering the morbidity and complications caused by this biopsy, can the non-invasive elevated serum eosinophil count be used as a predictive biomarker for LAR? Materials and Methods: Our research included patients with LDLT performed from June 2000 to June 2017 at Dokuz Eylül University Faculty of Medicine General Surgery Liver Transplant Unit, aged over 18 years and surviving at least 6 months. Patients developing late acute rejection were investigated in terms of demographic data, necessary graft weight/graft weight present ratio, cold ischemia duration, Child and MELD scores, doses of immunosuppressive agents before rejection, serum therapeutic levels and comorbidities. Our study retrospectively screened blood laboratory samples before biopsy and pathologic results of liver biopsies performed on patients with suspected LAR. Elevated serum eosinophil values were investigated and their effective role in diagnosis of LAR was researched. Results: Of 240 liver transplant cases included in the study, 65 (26.9%) had liver biopsy performed due to consideration of rejection linked to elevated liver function tests during follow-up. Of the biopsy transplant cases, 28 (43%) had LAR identified, while 37 (57%) had no finding of rejection encountered. The distribution of rejection in cases with rejection diagnosis was 10 (35.7%) mild, 13 (46.4%) moderate and 5 (17.9%) severe according to Banff pathology scoring. Of patients 21 (75%) were male and 7 (25%) were female. The mean follow-up duration was 3056 days (184-4877). The mean time of liver biopsy was the postoperative 660th day (180- 4354). There was a statistically significant correlation identified between elevated eosinophil count found in blood laboratory values before biopsy with LAR (p

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