Sindromul disfuncției multiple de organe în transplantul hepatic

Abstract

Introducere. Supraviețuirea pacienţilor cu MODS în transplantul de ficat scade la 60,3% (Mueller A.R.). Scop. Estimarea factorilor predispozanţi ai MODS -ului pentru perioada perioperatorie la pacienţii supuşi transplantului de ficat. Material şi metode. În studiu au fost incluşi 19 pacienţi după transplant de ficat divizaţi în două loturi: primul lot - 7 pacienţi care au întrunit criterii MODS, lotul doi – 12, fără criterii MODS. În lotul pacienţilor cu s-m MODS în perioada preoperatoriei scorul MELD a constituit 24, în lotul doi – 18. Printre agresiunile primare patologice severe care au putut provoca evoluţie în MODS s-au înregistrat: a. în preoperator sindrom porto-pulmonar la 2 pacienţi, sindrom CID – 3 pacienţi, sindrom hepatopriv şi colestatic sever – 7 pacienţi; b. intraoperator - hemoragie masivă la un pacient; c. postoperator - hemoragie masivă la 4, relaparatomie la 2, sindrom CID la 4, rejetul acut de grefă la trei recipienţi. La pacienţii suferinzi de MODS s-a constatat 2 insuficienţe de organe secundare la 3, a 3 sisteme de organe – 3 recipienţi, a 4 sisteme de organe – 1 recipient. Au decedat 4 recipienţi, la care MODS a inclus insuficienţe a 3 şi mai multe sisteme de organe. Concluzii. La pacienţii care au dezvoltat semne de sindrom MODS se observă o incidenţa mai înaltă a comorbidităţilor, depistate în preoperator, şi a diverselor sindroame severe induse de insuficienţa hepatică.

Introduction. Survival of patients with MODS in patients with liver transplantation is decreased to 60.3% (Mueller A.R.). Purpose. Assessment of MODS predisposing factors for perioperative period in patients undergoing liver transplantation. Material and methods. The study included 19 patients after liver transplantation divided into two groups: the first group - 7 patients who met the criteria for MODS, the second group -12 patients without MODS. In the group of patients with MODS during preoperative period the MELD score was - 24, in the second group - 18. Amongst the primary severe pathological aggressions which could develop MODS were recorded: a. In the preoperative period 2 patients presented with portopulmonary hypertension, 3 patients with DIC syndrome, cholestatic and severe hepatoprive syndrome - 7 patients; b. Intraoperative - excessive bleeding in one patient; c. Postoperative - excessive bleeding in 4 patients, relaparatomy in 2 patients, DIC syndrome in 4 patients and acute rejection in 3 patients. The MODS was presented with two secondary organ failure in 3 patients; three secondary organ failure in 3 patients and four secondary organ failure in 1 patient. From all of the patients, 4 of them died, in which MODS included 3 or more organ failure. Conclusions. In patients who have developed signs of MODS there is a higher incidence of comorbidities, detected in the preoperative period, and various syndromes induced severe hepatic failure.