Liver transplantation "our clinical 10 years experience"

Liver transplantation in end-stage liver failure is the only curative treatment alongside palliative treatments that can be done. The prolongation of graft survival has been provided with the improvements in surgery, anesthesia and immunology from the first liver transplantation was done to the present day. In our study, from April 2003 to October 2013, 195 patients who underwent liver transplantation in Akdeniz University Medical Faculty Hospital were reviewed retrospectively. Thirty five patients were excluded from the study due to non availability of admission files or anesthesia records. The data of 160 patients was evaluated. All the patients were divided into two groups: First group consists of the patients done in the first five years and second group of those done the last 5 years. The data collected were generally evaluated. Then the two groups were compared statistically by Mann-Whitney U, t test, chi-square test and Fisher's exact test, and Kaplan-Meier survival analysis. The etiology of the initial graft failure in our study, acute or chronic hepatitis B virus (HBV) infection in the first 5 years group (34.7%), as well as in the last 5 years group (34.1%) has been observed that in the first place. In the second group a slight decrease of HBV-dependent liver failure has been linked to increased vaccination study in the last decade. Hepatocellular cancer incidence with the primary causes of failure has increased to 8% from 1.4% (p<0.05). This condition is associated with an increased risk of HCC development has to be seen with treatment on the basis of primary etiologic factors. Patients who are categorized Child-Pugh grade A has increased to 22.7% from 8.3% (p<0.05). Increase in this ratio has been associated to raising awareness of the public and patients, diagnosis in the early stages of liver failure and an increased chance of being timely medical intervention. Also living donor liver transplantation rate increased to 31.8% from 12.5% (p<0.05). Patients who are categorized Child-Pugh grade A and B are being operated in more optimal conditions. The incidence of additional diseases is 36.1% in the first group, whereas 44.3% in the second group has risen (p<0.05). Liver transplantation in patients with comorbid diseases has increased opportunities with advancing technology and growing experience The use of inhaled anesthetic desflurane for maintenance of anesthesia increased to 71.6 % in the second group (p<0.05). It was 54.2% in the first group. The reason for this situation was considered to avoid the effects of sevoflurane nephrotoxic metabolites and to prevent worsening of symptoms in patients with impaired renal function. Inotropic or vasopressor requirement in cases where the use of noradrenaline compared to the first 5 years (31.9%) in last 5 years (54.5%) increased. The use of adrenaline increased to 21.6% from 12.7% (p<0.05). To achieve intraoperative low central venous pressure vasodilator therapy is well maintained. However, within the last 5 years term the use of vasodilators has been reduced and this ratio 60% has fallen from 73.6% (p<0.05).This was associated with the treatment of comorbidities (such as PHT) before worsening of diseases. The use of blood and blood products has decreased in last 5 years significantly (p<0.05). In the first five years group the mean of RBC replacement was 13.6, the second group was given an average 6.6 RBC. FFP used the mean number of 25.1 Ü in the first five year group and 10.6 Ü in the last five year group. Platelet used the mean number of 1.1 Ü in the first five year group and 0.8 Ü in the last five year group. This condition has been associated with increasing surgical experience, the development of surgical techniques, with increased experience of the anesthesiologist, and better graft presentation. Cell-saver and VVB use the last 5 years due to the potential for complications is reduced. When evaluated intraoperative fluid replacement first five years, the average amount given in 2980 mL of crystalloid, in the second five years it was 2,333 ml lower than first group (p<0.05). This condition has been associated with the increase in the experience of the surgical team, the growing low CVP approach in the last 5 years and the implementation of restricted fluid regimens. Surgeons, anesthesiologists, nurses and personnel experience, knowledge has increased from year to year. Therefore, operation time, ICU length of stay, postoperative mortality (30 day) has decreased (p<0.05). The average operation time was 410 min, while the first five years, the last 5 years has decreased to an average of 365 min's. The mean length of stay 5.3 days in intensive care in the first 5 years, the mean length of stay was 4.6 days in the second five years. Early mortality rate was 18.1% in the first five years group and has decreased to 11.3% in the second group. According to our experience, increase of clinical experience and knowledge is the most important factor in development of liver transplantation process and follow-up transplant patients. Patients, their relatives, public awareness has increased. While living donor liver transplantation rate increase with this sensitivity, reduce mortality and morbidity. As a result, sufficient clinical experience is required for each operation. Liver transplant requires special attention and care. Because the patients' hemodynamics may vary at any moment In the light of this information, further studies on the liver transplant anesthesia are needed to improve the anesthetic management of these patients