Avtor/Urednik		Rola, Eva; Ferk, Polonca; Mrhar, Aleš
Naslov		Retrospektivna analiza ambulantne imunosupresivne terapije pri bolnikih s presajenimi jetri
Prevedeni naslov		Retrospective analysis of outpatient immunosuppressive therapy in liver transplant patients
Tip		članek
Vol. in št.		Letnik 20, št. 2
Leto izdaje		2016
Obseg		str. 40-57
ISSN		1408-2756 - Gastroenterolog : revija slovenske gastroenterološke sekcije
Jezik		slv
Abstrakt		Izhodišče: Presaditev jeter je način zdravljenja pri bolnikih, ki imajo zadnji stadij jetrne bolezni in za bolnike z akutno ali kronično odpovedjo jeter. Namen naše raziskave je bil ovrednotiti, kako spol, starost ob presaditvi jeter, etiologija jetrne bolezni, zavrnitvena reakcija, retransplantacija, spremljajoče bolezni in izbor kombinacije imunosupresivov vplivajo na preživetje bolnikov po presaditvi jeter. Metode: V retrospektivno raziskavo smo vključili bolnike s presaditvijo jeter na KOGE UKC Ljubljana v obdobju 1.1.2007-31.12.2009. Analizirali smo zapise v podatkovni zbirki Hipokrat. Rezultati: Med 44 preiskovanimi bolniki je bilo 75% moških in 25% žensk. Povprečna starost bolnikov ob presaditvi jeter je bila (48,6%13,5) let. Eno in petletno preživetje bolnikov oz. presadkov po presaditvi jeter je bilo 81,8% in 65,9% oz. 79,5% in 59,1%. Najpogostejši vzrok za presaditev jeter je bila alkoholna jetrna ciroza (47,7%). Do zavrnitvene reakcije je prišlo pri 65,9% in do retransplantacije pri 13,6% bolnikov. Vsi bolniki so prejeli metilprednizolon, katerega so jim nato postopoma ukinjali. Večina bolnikov je na začetku zdravljenja prejemala ciklosporin, katerega so kasneje zamenjali za takrolimus, največkrat ob pojavu zavrnitvene reakcije, ko so bolnikom zvečali tudi odmerke metilprednizolona in po navadi uvedli mofetilmikofenolat. Nekateri bolniki so na začetku zdravljenja prejemali tudi azatioprin. Vzročno-posledične povezave med spremljanjem serumskih koncentracij ciklosporina in takrolimusa ter odmerjanjem nismo mogli ugotoviti. Najpogostejši pridruženi bolezni sta bili arterijska hipertenzija in sladkorna bolezen. Zaključek: Starost, zavrnitvena reakcija, retransplantacija, pridružene bolezni in kombinacija imunosupresivne terapije imajo verjetno pomemben vpliv na petletno preživetje bolnikov po presaditvi. Večina spremljajočih bolezni je bila verjetno posledica zdravljenja z imunosupresivi.Background: Liver transplantation is a mode of treatment in patients with end stage liver disease and in patients with acute or chronic liver failure. The purpose of our study was to evaluate how age at liver transplantation, etiology of liver disease, allograft rejection, retransplantation, concomitant diseases and immunosuppressive therapy may affect patients% survival after liver transplantation. Methods: This retrospective study involved liver transplantation patients at the Department of Gastroenterology at the Ljubljana University Medical Center in the period 1.1.2007-31.12.2009. Records from the Hipokrat database were analyzed. Results: There were more male (75%) than female (25%) patients. Their average age at liver transplantation was (48.6%13.5) years. The 1-year vs. 5-year patient and graft survival rates after liver transplantation were 81.8% and 65.9% vs. 79.5% and 59.1%. Alcoholic liver disease was the most common cause for liver transplantation (47.7%). Allograft rejection affected 65.9% of patients, whereas 13.6% needed retransplantation. All patients received methylprednisolone, which was gradually discontinued. The majority of patients received cyclosporine at the beginning of treatment, which was later exchanged for tacrolimus, most frequently following allograft rejection, when also methylprednisolone doses were increased and mycophenolate mofetil was usually introduced. Some patients also received azathioprine at the beginning of their treatment. Causative relationship between therapeutic drug monitoring of cyclosporine and tacrolimus in regard to their dosage regimen could not be determined. The most common concomitant diseases were arterial hypertension and diabetes. Conclusions: Age, allograft rejection, retransplantation, concomitant diseases and immunosuppressive therapy might have an important impact on 5-year patient survival rate after liver transplantation. The majority of concomitant diseases were probably side effects of the immunosuppressive treatment.
Proste vsebinske oznake		presaditev jeter indikacije imunosupresivno zdravljenje preživetje retrospektivna analiza