Tesis

Faktor-faktor yang memengaruhi rejeksi seluler akut pada pasien anak pascatransplantasi hati donor hidup di RSUPN dr. Cipto Mangunkusumo Jakarta = Risk factors contributing to acute cellular rejection on child living donor liver transplant recipient in Cipto Mangunkusumo Hospital, Jakarta.

Pendahuluan: Transplantasi hati donor hidup adalah tata laksana kuratif definitif untuk menatalaksana gagal hati stadium akhir pada pasien anak. Salah satu faktor yang sering menyebabkan komplikasi dan mengakitbatkan morbiditas dan mortalitas adalah rejeksi seluler akut. Penelitian Dogan, dkk. pada tahun 2018 menyebutkan ada beberapa faktor risiko yang berhubungan dengan rejeksi seluler akut pascatransplantasi hati, namun belum banyak penelitian di Indonesia yang membahas faktor risiko tersebut karena masih hanya satu pusat pendidikan yang sudah rutin melakukan tindakan transplantasi hati di Indonesia. Metode: Penelitian ini adalah studi kohort retrospektif dengan data didapat dari rekam medis di RSUPN Cipto Mangunkusumo, Jakarta dengan populasi seluruh pasien anak pascatransplantasi hati. Pasien diseleksi berdasarkan kriteria inklusi dan eksklusi yang ada, dengan faktor-faktor risiko meliputi warm ischemic time, cold ischemic time, status gizi, riwayat terinfeksi CMV, dan kadar takrolimus dalam darah saat terdiagnosis rejeksi seluler akut. Hasil: Didapatkan 80 pasien anak pascatransplantasi hati dari rekam medis, dan delapan puluh pasien yang memenuhi kriteria inklusi. Data kemudian diuji dengan Chi-Square menghasilkan korelasi signifikan antara rejeksi seluler akut dan riwayat terinfeksi CMV. Cold ischemic time juga meningkatkan risiko rejeksi seluler akut sebanyak 1.2 kali lipat walaupun secara uji signifikansi tidak bermakna. Kesimpulan: Faktor risiko yang berpengaruh terhadap rejeksi seluler akut di Indonesia adalah riwayat terinfeksi CMV yang dapat dihubungkan dengan pemberian takrolimus yang disesuaikan lebih rendah dari pasien tanpa riwayat terinfeksi CMV sebelumnya.
Kata kunci: LDLT, rejeksi seluler akut, faktor risiko


Background: Living donor liver transplant (LDLT) is one of definitive measures to treat terminal liver failure in children. One of the most frequently encountered complications and leading cause of morbidity and mortality were acute cellular rejection. According to Dogan et al. in 2018 there were several risk factors contributing to acute cellular rejection, but there are limited studies discussing the risk factors on child population in Indonesia and Jakarta as the only center perfoming LDLT in Indonesia. Objectives: The aim of this study is to give insights and identify risk factors contributing to acute rejection in child LDLT recipients. Methods: The study is cohort retrospective with data acquired from medical records in Cipto Mangunkusumo Hospital, Jakarta with population of all child LDLT recipients. The patients were selected based on predetermined inclusion and exclusion criteria, with risk factor variables including warm and cold ischemic time, nutritional status, history of CMV infection, and Tacrolimus level when diagnosed. Results: A total of 80 recipients were identified from the medical records. The data were then tested using the Chi-Square resulting in significant correlation between acute cellular rejection and history of CMV infection. Meanwhile, cold ischemic time also increases the risk of acute cellular rejection by 1.2 times although the correlation was not significant. Conclusion: The contributing risk factors for acute cellular rejections in Indonesia has been found that history of CMV infection is contributing in higher acute cellular rejection. It is suggested that patients with CMV infection history were more prone to acute rejection due to having adjusted low tacrolimus dose.
Keywords: LDLT, acute cellular rejection, risk factors