Experienta de 5 ani оn transplant hepatic

Hotineanu Vladimir; Hotineanu Adrian; Burgoci Serghei; Ivancov Grigore; Taran Natalia; Peltec Angela; Cazacu Dumitru; Sîrghi Vitalie

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2023-04-16 02:31

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HOTINEANU, Vladimir, HOTINEANU, Adrian, BURGOCI, Serghei, IVANCOV, Grigore, TARAN, Natalia, PELTEC, Angela, CAZACU, Dumitru, SÎRGHI, Vitalie. Experienta de 5 ani оn transplant hepatic. In: Chirurgia (București, Romania), 2018, nr. S1(113), pp. 69-70. ISSN 1221-9118.

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Chirurgia (București, Romania)

Numărul S1(113) / 2018 / ISSN 1221-9118

Experienta de 5 ani оn transplant hepatic

The 5-year experience in liver transplantation

Pag. 69-70

Hotineanu Vladimir, Hotineanu Adrian, Burgoci Serghei , Ivancov Grigore, Taran Natalia, Peltec Angela , Cazacu Dumitru, Sîrghi Vitalie

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“

Teze de doctorat:

Raportat: Boala ficatului gras nonalcoolic: opțiuni de diagnostic și de conduită terapeutică

Raportat: Optimizarea diagnosticului și tratamentului cancerului hepatic primar și metastatic

Disponibil în IBN: 12 decembrie 2021

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Din momentul primului transplant hepatic în Republica Moldova în 2013, am efectuat 40 de transplanturi hepatice, primele dintre ele
realizate în colaborare cu echipa chirurgicalã din Romania condusã de Profesorul Irinel Popescu. Deficitul critic de organe cadaverice
disponibile ne-au impus sã debutãm cu transplant hepatic cu hemificat drept de la donator viu. Într-o treime de transplanturi hepatice am
utilizat grefa de hemificat drept de la donator viu, iar in 2/3 cazuri grefa de ficat integru prelevat de la donator aflat în moarte cerebralã.
Indicaåiile pentru intervenåie chirugicalã în majoritatea cazurilor au fost ciroza hepaticã de etiologie viralã în faza terminalã, patru cazuri de
carcinom hepatocelular, câte un caz de cirozã biliarã primarã, hepatitã toxicã medicamentoasã æi retransplant hepatic cauzat de tromboza
arterei hepatice. În perioada postoperatorie precoce au decedat 4 primitori (2 primitori de grefã de la donatori vii æi 2 primitori de grefã de
la donatori aflaåi în moarte cerebralã). Cauzele decesului au fost: hemoragie intracerebralã în perioada postoperatorie precoce – 1, rejet acut
al grefei – 1, trombozã de arterã hepaticã – 1, disfuncåie primarã a grefei – 1. Nu au fost înregistrate decese în perioada postoperatorie
tardivã. Din complicaåiile survenite în perioada postoperatorie precoce putem remarca rejet acut al grefei - 2, trombozã de arterã hepaticã
– 1, hemoragie postoperatorie – 1, peritonitã biliarã – 1, disfuncåie primarã a grefei - 1, convulsii - 1, peritonitã cauzatã de ulcer acut duodenal
perforat – 1. Complicaåiile în perioada postoperatorie tardivã: peritonitã biliarã dupã extragerea drenului din coledoc, trombozã de
anastomozã a venei cava, rejet cronic a grefei. Experienåa acumulatã æi utilizarea tehnologiilor moderne ne-au permis sã reducem rata
mortalitãåii postoperatorii, la fel ca æi rata complicaåiilor survenite.

Since the first liver transplant in the Republic of Moldova in 2013, we have performed 40 liver transplants, the first of them
performed in collaboration with the surgical team from Romania, headed by Professor Irinel Popescu. The critical deficiency of
available cadaveric organs has forced us to begin with living donor liver transplantation, which represent one third of our cases. In the
rest of the cases we uses an integral liver graft taken from the brain-dead donors. Indications for surgical intervention in most cases
were hepatic cirrhosis of viral etiology, four cases of hepatocellular carcinoma, one case of primary biliary cirrhosis, drug toxic
hepatitis and liver retransplantation due to hepatic artery thrombosis. In the early postoperative period 4 recipients died (2
recipients from the living donor liver transplantation and 2 from brain-dead donors). Causes of death were: intracerebral haemorrhage
in the early postoperative period - 1, acute graft rejection - 1, hepatic artery thrombosis - 1, primary graft dysfunction - 1. There were
no deaths in the late postoperative period. From the complications occurring in the early postoperative period we can notice the acute
graft rejection - 2, hepatic artery thrombosis - 1, postoperative haemorrhage - 1, biliary peritonitis - 1, primary graft dysfunction – 1,
peritonitis caused by perforated acute duodenal ulcer - 1. Complications in late postoperative period: biliary peritonitis after biliary
drainage removing , anastomotic thrombosis of vena cava and chronic graft rejection. The accumulated experience and the use of
modern technologies have allowed us to reduce the rate of postoperative mortality, as well as the rate of complications.

Cuvinte-cheie
transplant hepatic, Transplant hepatic de la donator viu, Complicaåii posttransplant,

liver transplantation, living donor liver transplantation

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<title xml:lang='ro,en'>Experienta de 5 ani оn transplant hepatic</title>
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<publisher>Instrumentul Bibliometric National</publisher>
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<subject>transplant hepatic</subject>
<subject>Transplant hepatic de la donator viu</subject>
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<description xml:lang='ro' descriptionType='Abstract'><p>Din momentul primului transplant hepatic &icirc;n Republica Moldova &icirc;n 2013, am efectuat 40 de transplanturi hepatice, primele dintre ele<br />realizate &icirc;n colaborare cu echipa chirurgical&atilde; din Romania condus&atilde; de Profesorul Irinel Popescu. Deficitul critic de organe cadaverice<br />disponibile ne-au impus s&atilde; debut&atilde;m cu transplant hepatic cu hemificat drept de la donator viu. &Icirc;ntr-o treime de transplanturi hepatice am<br />utilizat grefa de hemificat drept de la donator viu, iar in 2/3 cazuri grefa de ficat integru prelevat de la donator aflat &icirc;n moarte cerebral&atilde;.<br />Indica&aring;iile pentru interven&aring;ie chirugical&atilde; &icirc;n majoritatea cazurilor au fost ciroza hepatic&atilde; de etiologie viral&atilde; &icirc;n faza terminal&atilde;, patru cazuri de<br />carcinom hepatocelular, c&acirc;te un caz de ciroz&atilde; biliar&atilde; primar&atilde;, hepatit&atilde; toxic&atilde; medicamentoas&atilde; &aelig;i retransplant hepatic cauzat de tromboza<br />arterei hepatice. &Icirc;n perioada postoperatorie precoce au decedat 4 primitori (2 primitori de gref&atilde; de la donatori vii &aelig;i 2 primitori de gref&atilde; de<br />la donatori afla&aring;i &icirc;n moarte cerebral&atilde;). Cauzele decesului au fost: hemoragie intracerebral&atilde; &icirc;n perioada postoperatorie precoce &ndash; 1, rejet acut<br />al grefei &ndash; 1, tromboz&atilde; de arter&atilde; hepatic&atilde; &ndash; 1, disfunc&aring;ie primar&atilde; a grefei &ndash; 1. Nu au fost &icirc;nregistrate decese &icirc;n perioada postoperatorie<br />tardiv&atilde;. Din complica&aring;iile survenite &icirc;n perioada postoperatorie precoce putem remarca rejet acut al grefei - 2, tromboz&atilde; de arter&atilde; hepatic&atilde;<br />&ndash; 1, hemoragie postoperatorie &ndash; 1, peritonit&atilde; biliar&atilde; &ndash; 1, disfunc&aring;ie primar&atilde; a grefei - 1, convulsii - 1, peritonit&atilde; cauzat&atilde; de ulcer acut duodenal<br />perforat &ndash; 1. Complica&aring;iile &icirc;n perioada postoperatorie tardiv&atilde;: peritonit&atilde; biliar&atilde; dup&atilde; extragerea drenului din coledoc, tromboz&atilde; de<br />anastomoz&atilde; a venei cava, rejet cronic a grefei. Experien&aring;a acumulat&atilde; &aelig;i utilizarea tehnologiilor moderne ne-au permis s&atilde; reducem rata<br />mortalit&atilde;&aring;ii postoperatorii, la fel ca &aelig;i rata complica&aring;iilor survenite.</p></description>
<description xml:lang='en' descriptionType='Abstract'><p>Since the first liver transplant in the Republic of Moldova in 2013, we have performed 40 liver transplants, the first of them<br />performed in collaboration with the surgical team from Romania, headed by Professor Irinel Popescu. The critical deficiency of<br />available cadaveric organs has forced us to begin with living donor liver transplantation, which represent one third of our cases. In the<br />rest of the cases we uses an integral liver graft taken from the brain-dead donors. Indications for surgical intervention in most cases<br />were hepatic cirrhosis of viral etiology, four cases of hepatocellular carcinoma, one case of primary biliary cirrhosis, drug toxic<br />hepatitis and liver retransplantation due to hepatic artery thrombosis. In the early postoperative period 4 recipients died (2<br />recipients from the living donor liver transplantation and 2 from brain-dead donors). Causes of death were: intracerebral haemorrhage<br />in the early postoperative period - 1, acute graft rejection - 1, hepatic artery thrombosis - 1, primary graft dysfunction - 1. There were<br />no deaths in the late postoperative period. From the complications occurring in the early postoperative period we can notice the acute<br />graft rejection - 2, hepatic artery thrombosis - 1, postoperative haemorrhage - 1, biliary peritonitis - 1, primary graft dysfunction &ndash; 1,<br />peritonitis caused by perforated acute duodenal ulcer - 1. Complications in late postoperative period: biliary peritonitis after biliary<br />drainage removing , anastomotic thrombosis of vena cava and chronic graft rejection. The accumulated experience and the use of<br />modern technologies have allowed us to reduce the rate of postoperative mortality, as well as the rate of complications.</p></description>
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