Yaşlılarda Organ Naklinde Öncesi ve Sonrası Hemşirelik Bakımı
Özet
Yaşlı nüfus tüm dünyada hızla artmaktadır. Yaşlı nüfusu arttıkça, organ nakli bekleme listelerindeki ve nakil olan yaşlı popülasyonu da artmaktadır. 2000 ve 2020 yılları arasında, karaciğer bekleme listesindeki 65 yaş üzeri alıcı adaylarının ve alıcıların oranı sırasıyla %5'ten %13'e ve %0,3'ten %1,3'e çıkmıştır. Organ nakli, yaşlı hastalarda yaşam kalitesinin iyileştirilmesi ve yaşam süresinin uzatılması olanağı sunmaktadır. Yaşlı nakil adayının nakil öncesi değerlendirmesi multidisipliner ekip eşliğinde ayrıntılı yapılmalıdır. Yaşlanma ile bağışıklığın baskılanması, ilaç metabolizmasının etkilenmesi, yaşlılığa bağlı artan kronik hastalıklar ve artan ilaç kullanımı nedeniyle yaşlıların immunosupresif ilaç dozaj miktarlarının kontrolü önemlidir. Yaşlı organ nakli alıcılarında kardiyovasküler hastalıklar, malignite ve kırık oluşma riski daha fazla olduğu için hastalar bu konularda daha kapsamlı değerlendirilmelidir.
Referanslar
World Health Organization. Ageing and health. In: World Health Organization; 2022. (14/02/2024 tarihinde https://www.who.int/news-room/fact-sheets/detail/ageing-and-health adresinden ulaşılmıştır).
United Nations. World population ageing. Department of Economic and Social Affairs Population Division. . (14/02/2024 tarihinde https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf adresinden ulaşılmıştır).
Türkiye İstatistik Kurumu. İstatistiklerle yaşlılar, 2017. (14/02/2024 tarihinde https://tuikweb.tuik.gov.tr/HbPrint.do?id=27595; 2018 adresinden ulaşılmıştır).
Lentine KL, Smith JM, Miller JM, Bradbrook K, Larkin L, Weiss S, et al. OPTN/SRTR 2021 annual data report: kidney. Am J Transplant. 2023;23(2):21-120.
Su F, Yu L, Berry K, Liou IW, Landis CS, Rayhill SC, et al. Aging of liver transplant registrants and recipients: trends and impact on waitlist outcomes, post-transplantation outcomes, and transplant-related survival benefit. Gastroenterology. 2016;150:441–453. https://doi.org/10.1053/j.gastro.2015.10.043.
Haldar D, Kern B, Hodson J, Armstrong MJ, Adam R, Berlakovich G, et al. Outcomes of liver transplantation for non-alcoholic steatohepatitis: a European Liver Transplant Registry study. J Hepatol. 2019;71(2):313-322.
Israni AK, Zaun D, Hadley N, Rosendale JD, Schaffhausen C, McKinney W, et al. OPTN/SRTR 2018 annual data report: deceased organ donation. Am J Transplant. 2020;20:509-541.
Kwong A, Kim WR, Lake JR. OPTN/SRTR 2018 annual data report: liver. Am J Transplant. 2020;20(s1):193–299.
Tajiri K, Shimizu Y. Liver physiology and liver diseases in the elderly. World J Gastroenterol. 2013;19:8459–8467.
Johansen KL, Chertow GM, Foley RN, Gilbertson DT, Herzog CA, Ishani A, et al. US renal data system 2020 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2021;77(4):7-8.
Huang E, Poommipanit N, Sampaio MS, et al. Intermediate-term outcomes associated with kidney transplantation in recipients 80 years and older: an analysis of the OPTN/UNOS database. Transplantation 2010;90:974-979
Tso PL. Access to renal transplantation for the elderly in the face of new allocation policy: a review of contemporary perspectives on “older” issues. Transplantation Reviews. 2014;28(1):6-14.
Abecassis M, Bridges ND, Clancy CJ, Dew MA, Eldadah B, Englesbe MJ, et al. Solid-organ transplantation in older adults: current status and future research. American Journal of Transplantation. 2012;12(10):2608-2622.
Sutherland AI, IJzermans JNM, Forsythe JLR, Dor FJMF. Kidney and liver transplantation in the elderly. Journal of British Surgery. 2016;103(2):62-72.
Caffo BS, Mehta SH, Singer AL, Taranto SE 4-4-, McBride MA, Montgomery RA. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303:959–966.
Cottone C, Pena Polanco NA, Bhamidimarri KR. Transplant of Elderly Patients: Is There an Upper Age Cutoff? Clin Liver Dis. 2021;25(1):209-227. doi: 10.1016/j.cld.2020.09.001.
Samji NS, Heda R, Satapathy SK. Peri-transplant management of nonalcoholic fatty liver disease in liver transplant candidates. Translational Gastroenterology and Hepatology. 2020;5:10.
Konerman MA, Fritze D, Weinberg RL, Sonnenday CJ, Sharma P. Incidence of and risk assessment for adverse cardiovascular outcomes after liver transplantation: a systematic review. Transplantation. 2017;101:1645–1657.
Martin P, DiMartini A, Feng S. Evaluation for liver transplantation in adults: 2013 practice guideline by the American association for the study of liver diseases and the American society of transplantation. Hepatology. 2014;59(3):1144–1165.
Keswani RN, Ahmed A, Keeffe EB. Older age and liver transplantation: a review. Liver Transplantation. 2004;10(8):957-967.
Kim D, Adejumo AC, Yoo ER. Trends in mortality from extrahepatic complications in patients with chronic liver disease, from 2007 through 2017. Gastroenterology. 2019;157(4):1055–1066.
Allen AM, Hicks SB, Mara KC. The risk of incident extrahepatic cancers is higher in non-alcoholic fatty liver disease than obesity - a longitudinal cohort study. Journal of Hepatology. 2019;71(6):1229–1236.
Allaire M, Nahon P, Layese R. Extrahepatic cancers are the leading cause of death in patients achieving hepatitis B virus control or hepatitis C virus eradication. Hepatology. 2018;68(4):1245–1259.
Gavara CG, Esposito F, Gurusamy K, Salloum C, Lahat E, Feray C, et al. Liver transplantation in elderly patients: a systematic review and first meta-analysis. HPB. 2019;21(1):14-25.
Martins PN, Tullius SG, Markmann JF. Immunosenescence and immune response in organ transplantation. International Reviews of Immunology. 2014;33(3):162–173.
Knoll G, Cockfield S, Blydt-Hansen T, et al. Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation. CMAJ. 2005;173(10):1-25.
Meier-Kriesche HU, Ojo A, Hanson J, et al. Increased immunosuppressive vulnerability in elderly renal transplant recipients. Transplantation. 2000;69(5):885-889.
Mousa OY, Nguyen JH, Ma Y. Evolving role of liver transplantation in elderly recipients. Liver Transplantation. 2019;25(9):1363–1374.
Aduen JF, Sujay B, Dickson RC. Outcomes after liver transplant in patients aged 70 years or older compared with those younger than 60 years. Mayo Clinic Proceedings. 2009;84(11):973–978.
EASL Clinical Practice Guidelines Liver transplantation. Journal of Hepatology. 2016;64(2):433–485.
Jeong HM, Kim DJ. Bone diseases in patients with chronic liver disease. International Journal of Molecular Sciences. 2019;20(17):4270.
Guichelaar MM, Schmoll J, Malinchoc M. Fractures and avascular necrosis before and after orthotopic liver transplantation: long-term follow-up and predictive factors. Hepatology. 2007;46(4):1198–1207.
Krenzien F, El Hajj S, Gabardi S. Immunosenescence and immunosuppressive drugs in the elderly. In: Fulop T, Franceschi C, Hirokawa K, Pawelec G. Handbook of Immunosenescence: Basic Understanding and Clinical Implications. Cham, Switzerland: Springer International Publishing, 2017; p. 2147–167.
Danovitch GM, Gill J, Bunnapradist S. Immunosuppression of the Elderly Kidney Transplant Recipient. Transplantation. 2007;84(3):285-291. DOI: 10.1097/01.tp.0000275423.69689.dc.
Cheungpasitporn W, Lentine KL, Tan JC, Kaufmann M, Caliskan Y, Bunnapradist S, et al. Immunosuppression considerations for older kidney transplant recipients. Current Transplantation Reports. 2021;8:100-110.
Durand F, Levitsky J, Cauchy F, Gilgenkrantz H, Soubrane O, Francoz C. Age and liver transplantation. Journal of Hepatology. 2019;70(4):745-758.
Ratcliffe J, Longworth L, Young T, Bryan S, Burroughs A, Buxton M. Assessing health-related quality of life pre- and post-liver transplantation: a prospective multicenter study. Liver Transplantation. 2002;8:263–270.
Referanslar
World Health Organization. Ageing and health. In: World Health Organization; 2022. (14/02/2024 tarihinde https://www.who.int/news-room/fact-sheets/detail/ageing-and-health adresinden ulaşılmıştır).
United Nations. World population ageing. Department of Economic and Social Affairs Population Division. . (14/02/2024 tarihinde https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf adresinden ulaşılmıştır).
Türkiye İstatistik Kurumu. İstatistiklerle yaşlılar, 2017. (14/02/2024 tarihinde https://tuikweb.tuik.gov.tr/HbPrint.do?id=27595; 2018 adresinden ulaşılmıştır).
Lentine KL, Smith JM, Miller JM, Bradbrook K, Larkin L, Weiss S, et al. OPTN/SRTR 2021 annual data report: kidney. Am J Transplant. 2023;23(2):21-120.
Su F, Yu L, Berry K, Liou IW, Landis CS, Rayhill SC, et al. Aging of liver transplant registrants and recipients: trends and impact on waitlist outcomes, post-transplantation outcomes, and transplant-related survival benefit. Gastroenterology. 2016;150:441–453. https://doi.org/10.1053/j.gastro.2015.10.043.
Haldar D, Kern B, Hodson J, Armstrong MJ, Adam R, Berlakovich G, et al. Outcomes of liver transplantation for non-alcoholic steatohepatitis: a European Liver Transplant Registry study. J Hepatol. 2019;71(2):313-322.
Israni AK, Zaun D, Hadley N, Rosendale JD, Schaffhausen C, McKinney W, et al. OPTN/SRTR 2018 annual data report: deceased organ donation. Am J Transplant. 2020;20:509-541.
Kwong A, Kim WR, Lake JR. OPTN/SRTR 2018 annual data report: liver. Am J Transplant. 2020;20(s1):193–299.
Tajiri K, Shimizu Y. Liver physiology and liver diseases in the elderly. World J Gastroenterol. 2013;19:8459–8467.
Johansen KL, Chertow GM, Foley RN, Gilbertson DT, Herzog CA, Ishani A, et al. US renal data system 2020 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2021;77(4):7-8.
Huang E, Poommipanit N, Sampaio MS, et al. Intermediate-term outcomes associated with kidney transplantation in recipients 80 years and older: an analysis of the OPTN/UNOS database. Transplantation 2010;90:974-979
Tso PL. Access to renal transplantation for the elderly in the face of new allocation policy: a review of contemporary perspectives on “older” issues. Transplantation Reviews. 2014;28(1):6-14.
Abecassis M, Bridges ND, Clancy CJ, Dew MA, Eldadah B, Englesbe MJ, et al. Solid-organ transplantation in older adults: current status and future research. American Journal of Transplantation. 2012;12(10):2608-2622.
Sutherland AI, IJzermans JNM, Forsythe JLR, Dor FJMF. Kidney and liver transplantation in the elderly. Journal of British Surgery. 2016;103(2):62-72.
Caffo BS, Mehta SH, Singer AL, Taranto SE 4-4-, McBride MA, Montgomery RA. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303:959–966.
Cottone C, Pena Polanco NA, Bhamidimarri KR. Transplant of Elderly Patients: Is There an Upper Age Cutoff? Clin Liver Dis. 2021;25(1):209-227. doi: 10.1016/j.cld.2020.09.001.
Samji NS, Heda R, Satapathy SK. Peri-transplant management of nonalcoholic fatty liver disease in liver transplant candidates. Translational Gastroenterology and Hepatology. 2020;5:10.
Konerman MA, Fritze D, Weinberg RL, Sonnenday CJ, Sharma P. Incidence of and risk assessment for adverse cardiovascular outcomes after liver transplantation: a systematic review. Transplantation. 2017;101:1645–1657.
Martin P, DiMartini A, Feng S. Evaluation for liver transplantation in adults: 2013 practice guideline by the American association for the study of liver diseases and the American society of transplantation. Hepatology. 2014;59(3):1144–1165.
Keswani RN, Ahmed A, Keeffe EB. Older age and liver transplantation: a review. Liver Transplantation. 2004;10(8):957-967.
Kim D, Adejumo AC, Yoo ER. Trends in mortality from extrahepatic complications in patients with chronic liver disease, from 2007 through 2017. Gastroenterology. 2019;157(4):1055–1066.
Allen AM, Hicks SB, Mara KC. The risk of incident extrahepatic cancers is higher in non-alcoholic fatty liver disease than obesity - a longitudinal cohort study. Journal of Hepatology. 2019;71(6):1229–1236.
Allaire M, Nahon P, Layese R. Extrahepatic cancers are the leading cause of death in patients achieving hepatitis B virus control or hepatitis C virus eradication. Hepatology. 2018;68(4):1245–1259.
Gavara CG, Esposito F, Gurusamy K, Salloum C, Lahat E, Feray C, et al. Liver transplantation in elderly patients: a systematic review and first meta-analysis. HPB. 2019;21(1):14-25.
Martins PN, Tullius SG, Markmann JF. Immunosenescence and immune response in organ transplantation. International Reviews of Immunology. 2014;33(3):162–173.
Knoll G, Cockfield S, Blydt-Hansen T, et al. Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation. CMAJ. 2005;173(10):1-25.
Meier-Kriesche HU, Ojo A, Hanson J, et al. Increased immunosuppressive vulnerability in elderly renal transplant recipients. Transplantation. 2000;69(5):885-889.
Mousa OY, Nguyen JH, Ma Y. Evolving role of liver transplantation in elderly recipients. Liver Transplantation. 2019;25(9):1363–1374.
Aduen JF, Sujay B, Dickson RC. Outcomes after liver transplant in patients aged 70 years or older compared with those younger than 60 years. Mayo Clinic Proceedings. 2009;84(11):973–978.
EASL Clinical Practice Guidelines Liver transplantation. Journal of Hepatology. 2016;64(2):433–485.
Jeong HM, Kim DJ. Bone diseases in patients with chronic liver disease. International Journal of Molecular Sciences. 2019;20(17):4270.
Guichelaar MM, Schmoll J, Malinchoc M. Fractures and avascular necrosis before and after orthotopic liver transplantation: long-term follow-up and predictive factors. Hepatology. 2007;46(4):1198–1207.
Krenzien F, El Hajj S, Gabardi S. Immunosenescence and immunosuppressive drugs in the elderly. In: Fulop T, Franceschi C, Hirokawa K, Pawelec G. Handbook of Immunosenescence: Basic Understanding and Clinical Implications. Cham, Switzerland: Springer International Publishing, 2017; p. 2147–167.
Danovitch GM, Gill J, Bunnapradist S. Immunosuppression of the Elderly Kidney Transplant Recipient. Transplantation. 2007;84(3):285-291. DOI: 10.1097/01.tp.0000275423.69689.dc.
Cheungpasitporn W, Lentine KL, Tan JC, Kaufmann M, Caliskan Y, Bunnapradist S, et al. Immunosuppression considerations for older kidney transplant recipients. Current Transplantation Reports. 2021;8:100-110.
Durand F, Levitsky J, Cauchy F, Gilgenkrantz H, Soubrane O, Francoz C. Age and liver transplantation. Journal of Hepatology. 2019;70(4):745-758.
Ratcliffe J, Longworth L, Young T, Bryan S, Burroughs A, Buxton M. Assessing health-related quality of life pre- and post-liver transplantation: a prospective multicenter study. Liver Transplantation. 2002;8:263–270.
