Canlı Vericili Karaciğer Nakli Sonrası Erken Re-Laparatomi: Nedenler, Risk Faktörleri ve Sonuçlar
Özet
Karaciğer nakli, son dönem karaciğer hastalıkları, primer karaciğer tümörleri ve fulminan karaciğer yetmezliği tedavisinde altın standart yöntemdir. Canlı vericili karaciğer nakli (CVKN) sonrası oluşan postoperatif komplikasyonlar, sgreftin özelliklerine, cerrahi tekniğe, alıcıda eşlik eden problemlere ve immünsüpresif tedavi gibi çeşitli faktörlere bağlıdır. Primer non-fonksiyon, akut T hücre aracılı rejeksiyon, kanama, enfeksiyon, vasküler komplikasyonlar ve safra yolu komplikasyonları en sık görülen erken dönem komplikasyonlar arasındadır.
CVKN sonrası ilk 30 gün içinde ortaya çıkan komplikasyonlar nedeniyle yapılan re-laparatomiler erken laparatomi olarak adlandırılır. CVKN sonrası erken re-laparatomi, hastaların %9.2-24.3’ ünde gerçekleştirilmektedir ve en sık postoperatif 1. gün yapılmaktadır. Erken re-laparatomilerin %70’i cerrahi tekniğe, %21’i ise hastaya bağlı nedenlerden ötürü gelişmektedir. Yüksek Model for End Stage Liver Disease (MELD) skoru, geçirilmiş karın cerrahisi öyküsü, massif asit varılığı, koaugülopati, uzamış ameliyat süresi, massif intraopetatif kanama, hastada ek ciddi hastalık öyküsü, hepatik ensefalopati, portal hipertansiyon CVKN sonrası erken laparatomi için başlıca risk faktörleridir. Postpopetarif kanama, vasküler komplikasyonlar (hepatik arter trombüsü, portal ven trombüsü ve hepatik venöz drenaj sorunları), biliyer komplikasyonlar, intraabdominal bilioma ve apse CVKN sonrası en sık relaparatomi nedenleridir. Erken re laparatomi greft ve hasta sağ kalaımını olumsuz etkileyen bir durumdur.
Liver transplantation is the gold standard method for the treatment of end-stage liver disease, primary liver tumors, and fulminant liver failure. Postoperative complications after living donor liver transplantation (LDLT) depend on various factors such as the characteristics of the graft, surgical technique, concomitant problems in the recipient, and immunosuppressive therapy. Primary non-function, acute T-cell mediated rejection, bleeding, infection, vascular complications, and biliary tract complications are among the most common early complications.
Re-laparotomies performed due to complications that occur within the first 30 days after LDLT are called early laparotomies. Early re-laparotomy after LDLT is performed in 9.2-24.3% of patients and is most frequently performed on the first postoperative day. 70% of early re-laparotomies develop due to surgical technique and 21% due to patient-related reasons. High Model for End Stage Liver Disease (MELD) score, history of previous abdominal surgery, presence of massive ascites, coagulopathy, prolonged surgery time, massive intraoperative bleeding, history of additional serious disease in the patient, hepatic encephalopathy, portal hypertension are the main risk factors for early laparotomy after CVKN. Postoperative bleeding, vascular complications (hepatic artery thrombus, portal vein thrombus and hepatic venous drainage problems), biliary complications, intraabdominal bilioma and abscess are the most common reasons for relaparotomy after CVKN. Early re-laparotomy is a situation that negatively affects graft and patient survival.
Referanslar
Raia S, Nery JR & Mies SL. (1989). Liver transplantation from live donors. Lancet; 8661: 497.
Strong RW & et al. (1990). Successful liver transplantation from a living donor to her son. N Engl J Med; 322: 1505.
Freise CE & et al. (2008). Recipient morbidity after living and deceased donor liver transplantation: findings from the A2ALL Retrospective Cohort Study. Am J Transplant; 8: 2569.
Li C & et al. (2011). Outcomes of patients with benign liver diseases undergoing living donor versus deceased donor liver transplantation. PLoS One; 6: e27366.
Lim M & et al. (2019). Early reoperation after adult living-donor liver transplantation is associated with poor survival. Korean J Transplant;33:128-134.
Bozkurt B, Dayangac M & Tokat Y. (2017). Living donor liver transplantation. Chirurgia (Bucur);112:217-28.
Mueller AR, Platz KP & Kremer B. (2004). Early postoperative complications following liver transplantation. Best Pract Res Clin Gastroenterol;18:881-900.
Yoshiya S & et al. (2012). The causes, risk factors, and outcomes of early relaparotomy after living-donor liver transplantation. Transplantation; 94: 947.
Kroon HM, Breslau PJ, Lardenoye JW. (2007) Can the incidence of unplanned reoperations be used as an indicator of quality of care in surgery? Am J Med Qual 22:198–202.
Moghadamyeghaneh Z & et al. (2018). A nationwide analysis of re-exploration after liver transplant. HPB, 20;216–221.
Hara T & et al. (2016). Analysis of early relaparotomy following living donor liver transplantation. Liver Transpl.;22(11):1519-1525.doi: 10.1002/lt.24500.
Ertugrul G, Tekin A & Zenciroglu M. (2021). Analysis of early relaparotomy in recipients of adult living donor liver transplantation. Arch Organ Transplant; 6(1):008-011.
Ertel AE & et al. (2016). Risk of reoperation within 90 days of liver transplantation: a necessary evil? J Am Coll Surg;222(4):419-428.
Neumayer L & et al. (2007). Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg; 204(6): 1178- 1187.
Okada N & et al. (2019). The Causes and Outcomes of Early Relaparotomy Following Pediatric Living Donor Liver Transplantation. Liver Transpl;25:(7)1066-1073.
Hendriks HG & et al. (2005). Intraoperative blood transfusion requirement is the main determinant of early surgical re-intervention after orthotopic liver transplantation. Transpl Int; 17: 673.
Soong RS & et al. (2012). The risk factors for early infection in adult living donor liver transplantation recipients. Transplant Proc;44(3):784-786.
Yıldırım S & et al. (2015) Treatment of biliary complications after liver transplant: results of a single center. Exp Clin Transplant 13:71–74.
Khalaf H. (2010). Vascular complications after deceased and living donor liver transplantation: a single-center experience. Transplant Proc;42(3): 865-870.
Park J. (2019). A retrospective analysis of re-exploration after living donor right lobe liver transplantation: incidence, causes, outcomes, and risk factors. Transplant Int; 32: 141–152.
Yoshizumi T & et al. (2008), The beneficial role of simultaneous splenectomy in living donor liver transplantation in patients with small-for-size graft. Transpl Int; 21: 833.
Lee SG & et al. (2007). Ligation of left renal vein for large spontaneous splenorenal shunt to prevent portal flow steal in adult living donor liver transplantation. Transpl Int; 20: 45.
Koç S & et al. (2021). Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplant: Single Center Experience. Exp Clin Transplant;19(8):832-841.
Referanslar
Raia S, Nery JR & Mies SL. (1989). Liver transplantation from live donors. Lancet; 8661: 497.
Strong RW & et al. (1990). Successful liver transplantation from a living donor to her son. N Engl J Med; 322: 1505.
Freise CE & et al. (2008). Recipient morbidity after living and deceased donor liver transplantation: findings from the A2ALL Retrospective Cohort Study. Am J Transplant; 8: 2569.
Li C & et al. (2011). Outcomes of patients with benign liver diseases undergoing living donor versus deceased donor liver transplantation. PLoS One; 6: e27366.
Lim M & et al. (2019). Early reoperation after adult living-donor liver transplantation is associated with poor survival. Korean J Transplant;33:128-134.
Bozkurt B, Dayangac M & Tokat Y. (2017). Living donor liver transplantation. Chirurgia (Bucur);112:217-28.
Mueller AR, Platz KP & Kremer B. (2004). Early postoperative complications following liver transplantation. Best Pract Res Clin Gastroenterol;18:881-900.
Yoshiya S & et al. (2012). The causes, risk factors, and outcomes of early relaparotomy after living-donor liver transplantation. Transplantation; 94: 947.
Kroon HM, Breslau PJ, Lardenoye JW. (2007) Can the incidence of unplanned reoperations be used as an indicator of quality of care in surgery? Am J Med Qual 22:198–202.
Moghadamyeghaneh Z & et al. (2018). A nationwide analysis of re-exploration after liver transplant. HPB, 20;216–221.
Hara T & et al. (2016). Analysis of early relaparotomy following living donor liver transplantation. Liver Transpl.;22(11):1519-1525.doi: 10.1002/lt.24500.
Ertugrul G, Tekin A & Zenciroglu M. (2021). Analysis of early relaparotomy in recipients of adult living donor liver transplantation. Arch Organ Transplant; 6(1):008-011.
Ertel AE & et al. (2016). Risk of reoperation within 90 days of liver transplantation: a necessary evil? J Am Coll Surg;222(4):419-428.
Neumayer L & et al. (2007). Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg; 204(6): 1178- 1187.
Okada N & et al. (2019). The Causes and Outcomes of Early Relaparotomy Following Pediatric Living Donor Liver Transplantation. Liver Transpl;25:(7)1066-1073.
Hendriks HG & et al. (2005). Intraoperative blood transfusion requirement is the main determinant of early surgical re-intervention after orthotopic liver transplantation. Transpl Int; 17: 673.
Soong RS & et al. (2012). The risk factors for early infection in adult living donor liver transplantation recipients. Transplant Proc;44(3):784-786.
Yıldırım S & et al. (2015) Treatment of biliary complications after liver transplant: results of a single center. Exp Clin Transplant 13:71–74.
Khalaf H. (2010). Vascular complications after deceased and living donor liver transplantation: a single-center experience. Transplant Proc;42(3): 865-870.
Park J. (2019). A retrospective analysis of re-exploration after living donor right lobe liver transplantation: incidence, causes, outcomes, and risk factors. Transplant Int; 32: 141–152.
Yoshizumi T & et al. (2008), The beneficial role of simultaneous splenectomy in living donor liver transplantation in patients with small-for-size graft. Transpl Int; 21: 833.
Lee SG & et al. (2007). Ligation of left renal vein for large spontaneous splenorenal shunt to prevent portal flow steal in adult living donor liver transplantation. Transpl Int; 20: 45.
Koç S & et al. (2021). Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplant: Single Center Experience. Exp Clin Transplant;19(8):832-841.
