University of Zagreb. School of Medicine. Department of Internal Medicine.
Abstract
Transplantacija jetre danas je postala rutinski oblik liječenja za bolesnike s kroničnim stadijem jetrene bolesti i akutnim zatajenjem jetre. Zahvaljujući velikom napretku u postoperativnom liječenju bolesnika s transplantacijom jetre vidljivo je nedvojbeno produljenje života tih bolesnika te manji broj umrlih. Napredak u liječenju prvenstveno je ostvaren u sprječavanju odbacivanja novoga organa i liječenju postoperativnih infekcija, koje uzrokuju najveći broj smrti transplantiranih bolesnika. Epidemiološka slika uzročnika ovisi o vremenu koje je proteklo od transplantacije pa tako u ranom postoperativnom tijeku većinu infekcija uzrokuju bakterije (većinom iz flore gram negativnih štapića i gram pozitivnih koka), dok s odmakom od operacije zastupljeniji postaju virusi i mikobakterije. Osobit problem, zbog visoke smrtnosti transplantiranih bolesnika, danas predstavljaju infekcije uzrokovane multiplorezistentnim patogenima (MDR, engl. multiple drug resistance) , za koje su nam terapijske mogućnosti izuzetno sužene, a u nekim slučajevima čak i ne postoje. Zbog izrazito velike i neracionalne primjene antibiotika za očekivati je daljnji porast rezistencije i otkrivanje novih MDR uzročnika. Iz tih razloga osobite napore treba uložiti u prevenciju infekcija, jer je prevencija najbolji oblik "liječenja".Liver transplantation has become routine way of treatment in patients with chronic stage of the liver disease and acute liver failure. Thanks to the great progress in the postoperative treatment of patients with the liver transplantation, the prolongation of life is undoubtely evident, as well as smaller number of deaths. Namely, the progress in treatment is primarily being achieved in prevention of the new liver rejection and postoperative infections treatment, which cause the greatest number of deaths in patients with liver transplant. Epidemiological picture of pathogens depends on the time that has elapsed since transplantation. In early postoperative course the majority of infections are being caused by bacteria (mostly gram negative bacilli and gram positive cocci), while in late postoperative course viruses and micobacteria are becoming more frequent. Particular problem nowadays, because of the high mortality in liver transplanted patients, are infections caused by multidrug-resistant pathogens, where therapeutic options are extremely reduced and even in some cases do not exist. Because of extremely large and irrational use of antibiotics, it is logical to expect a further increase in drug resistance and discovery of new multidrug-resistant pathogens. For these reasons, great efforts in prevention of infections should be made, because in the end the prevention is the best form of „treatment“
