Canlidan parsiyel karaciǧer transplantasyonu deneyimlerimiz

Aim: Partial liver transplantation from living related donors necessitates a different approach compared to cadaveric, transplantation. We present observations from our initial living related liver transplant program Materials and Methods: Between January 1994 and October 2002, nineteen living related liver transplantations were performed. Five were emergency cases due to fulminant hepatic failure and hepatic encephalopathy. Invasive hemodynamic monitors were placed under general anesthesia. Radial and femoral arterial pressures, central venous pressure, pulmonary arterial pressure, skin temperature and urine output were monitored in the recipients. Two central and three peripheral intravenous catheters were used to provide access for transfusion. At the end of surgery, donors were extubated while the recipients were mechanically ventilated. The retrospective data were analyzed by t-test. Results: Transplantation indications of the recipients were cirrhosis due to Hepatitis B (n=9), Wilson disease (n=4), autoimmune hepatitis (n=2), primary biliary cirrhosis (n=1) and isoniazid hepathotoxicity (n=1). For recipients and donors, respectively mean age was 32±12, 33±10 years, duration of anesthesia 9.9±1.9, 7.8±1.9 hours, fluid replacement 9919±2788, 7073±4286 mL, blood transfusion 11±6, 2.8±3 units, duration of stay in the intensive care unit 3.6±2.4, 1.0±0.8 days, mean graft harvesting time was 379±105 minutes. Intraoperative complications observed in donors included hypoglycemia, air embolism, bleeding, four recipients died during the early postoperative period due to vascular problems of the graft, inadequate graft function, sepsis and pulmonary edema (one each) resulting in an early survival ratio of 79%. There were no donor deaths. Conclusion: We conclude that living related liver transplantation may be safely performed by experienced anaesthesiology and surgical teams employing appropriate donor selection monitoring and perioperatif care.