Kalp transplantasyonu sonrası erken ve geç dönem komplikasyonlar
Küçük Resim Yok
Tarih
2002
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmanın amacı kalp transplantasyonu sonrasında erken ve geç dönemde görülen komplikasyonları değerlendirmektir. Materyal ve Metod: Şubat 1998 ve Haziran 2002 tarihleri arasında 21 olguya (15 erkek, 6 kadın; ortalama yaş 43.7 ± 14.2) kardiyak transplantasyon uygulanmıştır. Etiyoloji 13 olguda idiyopatik dilate kardiyomiyopati (%61.9), 7'sinde iskemik kardiyomiyopati (%33.3), 1 olgu da ise kapak hastalığı ve dilate kardiyomiyopati (%4.8) idi. Tüm olgularda biatriyal teknikle ortotopik kalp transplantasyonu uygulanmıştır. Bulgular: Ortalama kardiyak iskemi süresi 163.9 ± 59.5 dakikadır (101-335). Perioperatif mortalite 3 olgu ile %14.3'tür. Postoperatif dönemde 5 hasta kaybedilmiştir. Postoperatif erken dönemde 9 olguda (%42.8) inotropik destek gerekmiştir. Üçü hariç tüm olgular 24 saat içinde ekstübe edilmişlerdir. Sağ kalp yetmezliği, akut rejeksiyon ve akut böbrek yetmezliği perioperatif dönemde gözlenen en belirgin komplikasyonlardır. Akut rejeksiyon (9 hasta, %42.8) ve enfeksiyon (11 hasta, %52.4) erken takip dönemindeki morbiditelerin çoğundan sorumludurlar. Bir olguda transplantasyon sonrası 2. ayda akciğerde lenfoproliferatif hastalık saptanmıştır. İlk 6 ay içinde 3 olguda mortalite gözlenmiştir. Geç dönemde bir olguda fatal sonuçlanan mediastinal lenfoproliferatif hastalık, diğer bir olguda ise ayakta Kaposi sarkomu tespit edilmiştir. Olguların önemli bölümünde geç dönemde hipertansiyon (7 hasta %33.3), renal disfonksiyon (5 hasta %23.8) ve insüline bağımlı diyabet (2 hasta %9.5), hiperlipidemi (9 hasta %42.9) ortaya çıkmıştır. Koroner anjiyografi ve intravenöz ultrasonografi tetkikleri sonrası 2 olguda geç dönem allograft vaskülopatisi saptanmıştır. Sonuç: Erken dönemde akut rejeksiyon ve enfeksiyonlar mortalite ve morbiditenin en önemli nedenleridir. Geç dönemde ise immunsupressif tedavinin metabolik yan etkileri yanında maligniteler ve allogreft vaskülopatisi de gözlenmektedir.
Background: the objective of this study was to evaluate short and long-term complications after cardiac transplantation. Methods: Between February 1998 and June 2002, 21 patients (15 male and 6 female; mean age 43.7 ± 14.2 years) underwent cardiac transplantation. Etiology was idiopathic dilated cardiomyopathy in 13 patients (61.9%), ischemic cardiomyopathy in 7 (33.3%), and valvular heart disease and dilated cardiomyopathy in 1 (4.8%). Orthotopic cardiac transplantation using biatrial technique was used in all patients. Results: the mean cardiac ischemia time was 163.9 ± 59.5 minutes (101-335). Perioperative mortality was 14.3% with 3 deaths. Five patients were expired in postoperative period. Inotropic support was needed for 9 patient (42.8%) at early postoperative period. All patients were extubated within 24 hours except 3 of them. Right ventricular failure, acute rejection and acute renal failure were the most prominent complications during perioperative period. Acute rejection (9 patients, 42.8%) and infection (11 patients, 52.4%) were responsible most of the morbidities at early follow-up period. in one patient lymphoproliferative disease in lung was seen at two months after transplantation. Mortality was seen in 3 patients within postoperative 6 months. Fatal mediastinal lymphoproliferative disease was observed in one patient, and Kaposi's sarcoma of foot in the other during late follow-up period. in considerable number of patients, side effects of immunosuppressive therapy such as hypertension (7 patients, 33.3%), chronic renal dysfunction (5 patients, 23.8%), insulin dependent diabetes (2 patients, 9.5%) and hyperlipidemia (9 patients, 42.8%) were seen at late follow-up period. in 2 patients, allograft vasculopathy was detected in coronary angiography and intravenos ultrasonography during late follow-up period. Conclusions: in short-term follow-up, acute rejection and infection play a dominant role in mortality and morbidity. the predominant causes of morbidity in long-term follow-up are related with metabolic side effects of immunosuppressive therapy as well as malignancies and allograft vasculopathy.
Background: the objective of this study was to evaluate short and long-term complications after cardiac transplantation. Methods: Between February 1998 and June 2002, 21 patients (15 male and 6 female; mean age 43.7 ± 14.2 years) underwent cardiac transplantation. Etiology was idiopathic dilated cardiomyopathy in 13 patients (61.9%), ischemic cardiomyopathy in 7 (33.3%), and valvular heart disease and dilated cardiomyopathy in 1 (4.8%). Orthotopic cardiac transplantation using biatrial technique was used in all patients. Results: the mean cardiac ischemia time was 163.9 ± 59.5 minutes (101-335). Perioperative mortality was 14.3% with 3 deaths. Five patients were expired in postoperative period. Inotropic support was needed for 9 patient (42.8%) at early postoperative period. All patients were extubated within 24 hours except 3 of them. Right ventricular failure, acute rejection and acute renal failure were the most prominent complications during perioperative period. Acute rejection (9 patients, 42.8%) and infection (11 patients, 52.4%) were responsible most of the morbidities at early follow-up period. in one patient lymphoproliferative disease in lung was seen at two months after transplantation. Mortality was seen in 3 patients within postoperative 6 months. Fatal mediastinal lymphoproliferative disease was observed in one patient, and Kaposi's sarcoma of foot in the other during late follow-up period. in considerable number of patients, side effects of immunosuppressive therapy such as hypertension (7 patients, 33.3%), chronic renal dysfunction (5 patients, 23.8%), insulin dependent diabetes (2 patients, 9.5%) and hyperlipidemia (9 patients, 42.8%) were seen at late follow-up period. in 2 patients, allograft vasculopathy was detected in coronary angiography and intravenos ultrasonography during late follow-up period. Conclusions: in short-term follow-up, acute rejection and infection play a dominant role in mortality and morbidity. the predominant causes of morbidity in long-term follow-up are related with metabolic side effects of immunosuppressive therapy as well as malignancies and allograft vasculopathy.
Açıklama
Anahtar Kelimeler
Kalp ve Kalp Damar Sistemi, Cerrahi
Kaynak
Türk Göğüs Kalp Damar Cerrahisi Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
10
Sayı
3