University of Zagreb. School of Medicine. Chair of Internal Medicine.
Abstract
Broj transplantacija jetre je u porastu. Napredne kirurške tehnike, moderna imunosupresija i bolja peri- i postoperativna skrb dovele su do duljeg preživljenja primatelja. S većim brojem zahvata i duljim preživljenjem, povećao se i broj komplikacija. Bolesti probavne cijevi dio su patologije koja se susreće kod transplantiranih pacijenata. Najvažnije komplikacije su infekcije i maligne bolesti, oboje usko povezani s imunosupresivnom terapijom. Komplikacije povećavaju morbiditet, rizik od odbacivanja i mortalitet primatelja, pa je njihovo pravovremeno prepoznavanje i liječenje od izrazite važnosti kod transplantiranih pacijenata. Endoskopski pregledi igraju važnu ulogu u ranom otkrivanju bolesti probavne cijevi. Patologija gornjeg dijela probavne cijevi najčešće uključuje ezofagitis, koji može biti infektivni (CMV, Candida) i ne-infektivni (refluksni, eozinofilni). Osim ezofagitisa pojavljuju se i varikoziteti jednjaka, ezofagealni karcinom i PTLD koji može zahvatiti cijelu duljine probavne cijevi. U donjem dijelu najčešći je infektivni kolitis (C.difficile, CMV), te ne-infektivne upale (EGID, IBD). Znatno rjeđe nalazimo Kaposijev sarkom, kolorektalni karcinom i GvHD. Bolesti poput GvHD, visceralnog Kaposijevog sarkoma, invazivne kandidijaze i PTLD-a imaju vrlo visoki mortalitet. Ovaj rad daje pregled najčešćih bolesti probavne cijevi u transplantiranih pacijenata, te njihove epidemiologije, kliničke slike, dijagnostičkih postupaka i terapije.The number of liver transplant recipients has increased. Advanced surgical techniques, modern immunosuppression and better peri- and postoperative care all led to better survival rates. Increased number of procedures and longer survival has resulted in higher frequency of complications. Digestive tract diseases are part of the pathology that can be encountered in liver transplant recipients. Infections and malignant diseases are most important complications, both connected with the immunosuppressive regimen. Complications have serious impact on morbidity, allograft rejection and recipient mortality, therefore early detection and treatment is of great importance in liver transplant recipients. Endoscopy plays major role in early detection of digestive tract diseases. Pathology of the upper GI tract most often includes esophagitis, which can be infectious (CMV, Candida) or non-infectious (reflux, eosinophilic). Besides esophagitis, a number of diseases can be found, including esophageal varices, esophageal carcinoma and PTLD, which can be seen throughout the whole length of GI tract. Most frequent pathology of the lower GI tract is infectious colitis (C. difficile, CMV) and non-infectious inflammatory disease (EGID, IBD). Kaposi’s sarcoma, colorectal carcinoma and GvHD are rare. Graft - versus - host disease, visceral form of Kaposi’s sarcoma, invasive fungal infection and PTLD has high mortality rate. This paper reviews most frequent digestive tract diseases in transplant recipients, and their epidemiology, clinical presentation, diagnostic procedures, and therapy
