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Amaç: Karaciğer nakli yapılan hastalardaki postoperatif erken dönemde gelişen akut rejeksiyonların belirlenmesinde enflamatuar parametrelerin önemini araştırmayı amaçladık. Gereç ve Yöntem: 2020 yılında Yeditepe Üniversitesi Hastanesinde yapılan karaciğer nakilleri sonrası erken dönemde rejeksiyon gelişen hastaların, preoperatif, rejeksiyon geliştiğinde ve pulse steroid tedavi sonrası taburculuğundaki hemoglobin, Nötrofil/Lenfosit oranı, AST/Lenfosit oranı, AST/Nötrofil oranı, ALT/Lenfosit oranı, ALT/Nötrofil oranı , CRP/Albumin oranı, Glukoz, tacrolimus ve GRWR (Graft recipient weight ratio) düzeylerine bakıldı. Rejeksiyon gelişmeyen grubun da preoperatif ve taburcu edildiğindeki değerlerine bakıldı. Bulgular: Karaciğer nakli yapılan 34 hastadan sekizinde (%23,5) postoperatif erken dönemde ilk bir ayda akut rejeksiyon gelişti. Rejeksiyon gelişen hastalarda ALT ve AST değerlerinin tedavinin farklı aşamalarındaki değişimleri açışından anlamlı farklılıkların olduğu görüldü (p<0.005). Pre-transplantasyon ve taburculuk öncesi ölçülen hemoglobin, trombosit, nötrofil, lenfosit, ALT, AST ve serum glukoz değerleri arasında anlamlı farklılık tespit edilmedi (p>0.05). Rejeksiyon gelişen hastaların preoperatif albümin değeri, rejeksiyon gelişmeyen hastalardan anlamlı olarak daha düşüktü (p=0.040). Pre-transplantasyon CRP değerleri arasındaki fark anlamlı idi (p=0.035). Yapılan çoklu analizlerde, pre-transplantasyon dönemine göre rejeksiyon aşamasında nötrofil/lenfosit (p=0.026), AST/lenfosit (p=0.003), ALT/lenfosit (p<0.001) ve ALT/nötrofil (p=0.003) oranlarında anlamlı idi. Sonuç: Akut rejeksiyon transplantasyondan günler sonra ortaya çıkabilen ve greft kaybı ile sonuçlanabilen bir tablodur. Tedavisinde doğru tanıyı destekleyecek parametrelerin önemi her geçen gün daha da artmaktadır.
Purpose: We aimed at investigating the importance of inflammatory parameters in the determination of acute rejection developing in postoperative early periods in patients with hepatic transplant. Tools and Methods: In 2020, after hepatic transfusions in the Yeditepe University Hospital, patients developing rejection in the early stages, preoperative, rejection and post-pulsed steroid treatment with hemoglobin, neutrophil/lenfocytes, AST/lenfocytes, AST/lenfocytes, ALT/lenfocytes, ALT/lenfocytes, ALT/lenfocytes, CRP/Albumin, glucose, tacrolimus and GRWR (Graft recipient weight ratio) levels were considered. The recession was also considered to be the values of the non-developed group preoperative and dismissed. Results: Eight of the 34 patients with hepatic transplant (23,5%) developed acute rejection in the first month of the postoperative early period. In developing patients with recession, significant differences in ALT and AST values were found from opening changes in different stages of treatment (p<0.005). There was no significant difference between pre-transplantation and pre-extrusion measureed hemoglobin, thrombocytes, neutrophils, lymphocytes, ALT, AST and serum glucose values (p>0.05). The preoperative albumin value in patients developing with rejection was significantly lower than in patients not developing with rejection (p=0.040). The difference between pre-transplantation CRP values was significant (p=0.035). In multiple analyses, the neutrophils/lenfocytes in the rejection stage (p=0) depending on the pre-transplantation period. It was significant in the ratio of AST/lenfocytes (p=0.003), ALT/lenfocytes (p<0.001) and ALT/natrophils (p=0.003). The result: Acute rejection is a table that can occur days after transplantation and result in loss of the infection. The importance of the parameters that support the correct diagnosis in treatment increases every day.
Aim: We aimed to investigate the importance of inflammatory parameters in determining acute rejection in the early post-operative period in liver transplant client. Materials and Methods: When rejection was developed and after pulse steroid therapy, Preoperative, Hemoglobin, Neutrophil / Lymphocyte rate, AST / Lymphocyte rate, AST / Neutrophil rate, ALT / Lymphocyte rate, ALT / Neutrophil rate, CRP / Albumin rate, Glucose, tacrolimus and GRWR (Graft recipient weight ratio) levels of clients who developed rejection in the early period after liver transplantation performed Yeditepe University Hospital in 2020 were measured. Preoperative and discharge values of the group without rejection were also evaluated. Results: Acute rejection developed in the first one month in the early postoperative period at eight (23.5%) of 34 clients who underwent liver transplantation. It was observed that there were significant differences in terms of changes in ALT and AST values at different stages of treatment in clients who developed rejection (p=0.01). The preoperative albumin value of the clients who developed rejection was significantly lower than the clients who did not develop rejection (p=0.040). The difference among pre-transplantation CRP values was significant (p = 0.035). In the multiple analyzes performed, the ratio of neutrophil/lymphocyte (p=0.026), AST/lymphocyte (p=0.003), ALT/lymphocyte (p<0.001) and ALT/neutrophil (p=0.003) at the rejection stage according to the pre-transplantation period was significant. Conclusion: Acute rejection can occur days after transplantation and may lead to graft failure. The importance of parameters that supports the correct diagnosis in treatment is increasing day by day.
Field : Sağlık Bilimleri
Journal Type : Uluslararası
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