Transplantul hepatic – evaluarea de durată a recipienţilor

Abstract

Introducere: Transplantul hepatic (TH) reprezintă tratamentul cirozei hepatice în stadiul terminal. Complicaţiile postoperatorii se atestă oricărui proces chirurgical, fiind precoce în prima lună şi tardive după acest interval. Scopul: Evaluarea recipienţilor post-transplant (2013-2015). Material si metode: Studiul include 35 recipienţi, vîrsta medie 46,74±1,89 ani, 23 (65,71 %) – bărbaţi, 12 (34,29%) – femei. La 9 (25,71%) – realizat TH de la donator viu, la 24 (68,57%) – TH de la donator în moarte cerebrală, la 2 (5,71%) – TH cu ficat împărţit. La 13 (37,14%) – efectuat TH în RM. Etiologia maladiei: virală (VHB – 4; VHC – 7; VHD – 18); VHD/CHC – 2, fibroză hepatică idiopatică – 1, insuficienţă hepatică acută – 2, ciroză biliară primitivă – 1. Tratamentul de imunosupresie: standart, conform protocolului. Rezultate: Complicaţii precoce: a). tromboză de arteră hepatică – 1 (2,86%); b). rejet acut – 3 (8,57%), 1 – tratat prin pulsterapie; c). hemoragie intracerebrală – 1 (2,86%); d). complicaţii medicale: pulmonare – 4 (11,43%), renale – 3 (8,57%), neurologice – 3 (8,57%); e). complicaţii biliare – fistulă tranşă secţiune hepatică – 2 (5,71%), peritonită biliară – 1 (1,86%). Complicaţii tardive: a). biliare prin stenoză anastomotică – 4 (11,43%), 2 rezolvate prin stentare; b). rejet cronic – 2 (5,71%); c). complicaţii medicale – insuficienţă renală – 3 (8,57%), hipertensiune arterială – 2 (5,71%), dislipidemii – 2 (5,71%), obezitate – 1 (1,86%); d). recidivă a afecţiunilor primare post-transplant: VHB – 1, VHC – 5, din care 1 cu răspuns susţinut. Mortalitatea postoperatorie – 3 (8, 57%): hemoragie intracerebrală – 1, rejet acut – 2. Concluzii: Complicaţiile postoperatorii precoce s-au estimat în 61,54%: chirurgicale 23,07%, terapeutice 38,46%; printre complicaţiile tardive predomină cele terapeutice 45,71%, supravieţuirea grefei – 91,43%.

Introduction: Liver transplantation (LT) is the treatment of end-stage liver cirrhosis. Postoperative complications are as per any surgical process, observed too early if in first month and too late after this period. Aim: Assessment of post-transplant recipients, across time (2013-2015). Material and methods: The study included 35 recipients, average age 46.74±1.89, 23 (65.71%) – men, 12 (34.29%) – women. 9 (25.71%) transplanted from living donor, 24 (68.57%) – whole liver, brain-dead donor, 2 (5.71%) – split liver. 13 (37.14%) recipients were transplanted in Republic of Moldova. Disease etiology: viral (HBV – 4, HCV – 7, HDV – 18); HDV/CHC – 2, idiopathic hepatic fibrosis – 1, acute liver failure – 2, primary biliary cirrhosis – 1. Immunosuppression treatment: standard, according to protocol. Results: Early complications: a). hepatic artery thrombosis – 1 (2.86%); b). acute rejection – 3 (8.57%), of which 1 (2.86%) treated through pulse-therapy; c). intracerebral hemorrhage – 1 (2.86%); d). medical complications: pulmonary – 4 (11.43%), renal – 3 (8.57%), neurological – 3 (8.57%); e). biliary complications – liver fistula installment section – 2 (5.71%), biliary peritonitis – 1 (1.86%). Late complications: a). biliary anastomotic stenosis – 4 (11.43%), of which 2 (5.71%) resolved through stenting; b). chronic rejection – 2 (5.71%); c). medical complications – kidney failure – 3 (8.57%), hypertension – 2 (5.71%), dyslipidemia – 2 (5.71%), obesity – 1 (1.86%); d). primary disease relapse post-transplant: HBV – 1, HCV – 5, of which 1 sustained response. Postoperative mortality – 3 (8.57%): intracerebral hemorrhage – 1, acute rejection – 2. Conclusions: Early postoperative complications were estimated at 61.54%: 23.07% – surgical, therapeutic – 38.46%; therapeutic complications – 45.71%, prevail among tardive complications, graft survival – 91.43%.