[Show abstract][Hide abstract] ABSTRACT: Use of livers from cadaveric nonstandard donors has become justified, especially for recipients awaiting urgent transplantations. However, it is known that results are superior when organs are obtained from ideal rather than expanded-criteria donors. We designed a study to compare the characteristics of 582 liver donors whose organs were used for elective versus urgent transplantations in 2006-2008 and the recipients' outcomes. Donors and recipients were classified into 2 groups: 1) elective (n = 387); and 2) urgent transplantations (n = 195). We evaluated 12 donor risk factors: age >55 years, alcohol ingestion, intensive care unit stay >4 days, hypotensive episodes (<70 mm Hg >10 min), noradrenaline dose >0.1 μg/kg/min, anti-hepatitis B of core (+), Na level >155 mmol/L, international normalized ratio >1.5, aspartate transaminase >140 U/L, alanine transaminase >170 U/L, bilirubin >2.0 mg/dL, and changes in liver sonography. There were no significant differences in the frequency of incidence of 11 donor risk factors in both groups. Only sodium level >155 mEq/L significantly (P = .04) differed. Donors for elective recipients showed this factor more frequently than the urgent cohort. The mean number of risk factors per donor among the elective cases was 2.28 and for the urgent cases 2.3, a difference that was not significant. In almost all cases of liver transplantations (94%), donor-related risk factors were acceptable. The criteria for cadaveric liver donors were not different for elective versus urgent recipients; biologic characteristics of the transplanted organs were similar in both groups. A tendency was not observed to expand donor criteria for urgent recipients.
[Show abstract][Hide abstract] ABSTRACT: First incidences of HIV or AIDS disease in Poland were reported in 1985. Up to the end of 2008 0,03% of polish population had been infected of HIV virus.
The aim of this document was determination of HIV occurrence in Polish organ donor population in 1998–2008, determination of percentage of withdrawal in case of HIV infection, determination of HIV positive organ donor profile and comparison of frequency of HIV infection in deceased organ donors and general population in Poland.
In 1998–2008 5954 possible deceased organ donors had been reported to Polish Transplant Coordinating Center Poltransplant, organ recovery took place in 4875 (82%) cases In 1079 cases (18 %) organs were not recovered because of medical reasons (46%) and family or prosecutor objections (54%).
HIV antibodies had been tested in 90% possible organ donors. Positive HIV antibodies were reported in 0,3% cases.
The occurrence of HIV infection in deceased organ donors in Poland in the years 1998–2008 was 10 times higher than in general Polish population. In general population HIV infections occur mainly in young people, in possible organ donor population infections occurred mostly between older one.
HIV infection in donor is rare but significant reason of withdrawal.
No preview · Article · Dec 2009 · HIV and AIDS Review
[Show abstract][Hide abstract] ABSTRACT: Hepatocellular carcinoma (HCC) is a major cause of death worldwide. Over half a million people die of this cancer annually. This article is an attempt to summarize the current view on HCC diagnostics. The roles of imaging techniques, liver biopsy evaluation, and serum tumor marker determination are presented. It is pointed out that better radiological techniques which can show vascularization patterns of hepatocellular carcinoma have improved the accuracy of noninvasive diagnosis. The advantages of contrast-enhanced sonography, computed tomography, and magnetic resonance imaging are underlined. At the same time, the limitations of each imaging modality in detecting HCC, especially in cases of small tumors, are presented. As a supplementary tool for imaging techniques, the serum markers AFP-L3, AFP mRNA, AFU, GPC-3, and DCP, besides the commonly used AFP, are described. New serum markers, cytokines such as VEGF, IL-8, IGF-II, and hTERT, are shown as a potential means to enhance the diagnostic process. Risk factors for HCC as well as the changing proportion of HBV/HCV viruses as HCC inducers are evaluated; the dominance of HCV as a viral cause of this cancer since 1990 is observed in the developed countries. Newly established risk factors, including genetic disorders such as bile salt export pump deficiency, are also presented.
[Show abstract][Hide abstract] ABSTRACT: Hepatocellular carcinoma (HCC) is the 4th most frequent cancer worldwide and the 3rd cause of death from neoplastic disease. Consequent screening of groups at risk, particularly post-inflammatory HBV and HCV cirrhosis patients, allows early detection of liver lesions. Thorough radiological studies, supplemented with molecular diagnostics, permit early-stage HCC detection. Of numerous classifications used in HCC, the one proposed by Barcelona center (Barcelona Clinic Liver Cancer - BCLC) seems the most accurate. Based on the stage of liver insufficiency and progression of tumor, the classification delineates most adequate treatment modality: resection, transplantation, thermoablation, chemoembolization or molecular therapy. Patients, who fit into Mediolan criteria have overall survival of 60-70%. Similar results can be achieved with the resection in patients with satisfactory liver function. Contemporarily, thermoablation and chemoembolization should not be considered as methods of palliation, but alternatives for the liver resection in patients with small tumor size, who otherwise cannot be qualified for surgery or a bridge to liver transplantation. Molecular therapy with sorafenib proved to increase survival in advanced HCC. There are also some ongoing studies of combination therapy with sorafenib and other HCC treatment methods.
No preview · Article · Jan 2009 · Gastroenterologia Polska
[Show abstract][Hide abstract] ABSTRACT: In the years 2001 to 2005 in Poland, 3146 potential deceased donors were referred with 2583 (82%) organs procured and 57 (2%) donors not used due to positive viral markers. According to Polish rules, in every case of possible organ harvest from a deceased donor we test viral markers of anti-HIV I/II, HBsAg, and anti-HCV. Organs from HBsAg-positive donors (the rule accepted in Poland a few years ago) are not transplanted; kidneys from anti-HCV(+) donors are transplanted into matched recipients. According to donor hospital capabilities, other viral tests are performed: anti-HBs, anti-HBc, HBeAg, and anti-HBe. We calculate the frequency of positive serological tests for viral markers among the population of deceased donors, for HBsAg it was 1.1% (from these donors 10 kidneys and 1 liver were transplanted); and for anti-HCV it was 2.6% (from these donors 78 kidneys were used). Anti-HBc-positive deceased donors, particularly liver donors (due to the high risk of viral transmission and de novo infection), are a major problem in transplantation, which reduced the number of used organs. Only 17 of 86 (20%) of the HBc-positive donors became liver donors compared with 257 of 524 (49%) donors from the HBc-negative group. But anti-HBc was checked only in 24% of potential donors (positive in 16.6% of cases), which means that 506 of 780 transplanted livers (65%) were obtained from donors of unknown anti-HBc status, 257 (33%) from anti-HBc-negative subjects and 17 (2%) from anti-HBc-positive subjects.
Full-text · Article · Dec 2007 · Transplantation Proceedings
[Show abstract][Hide abstract] ABSTRACT: Background: Chronic HBV and HCV infections with hepatic cirrhosis are regarded as the most common factors leading to the development of hepatocellular carcinoma (HCC). Case Report: The authors present the cases of HCC developed in the course of chronic hepatotropic HBV and HCV infections without coincident hepatic cirrhosis. Conclusions: The authors emphasize the necessity of USG and AFP level monitoring in patients with chronic hepatitis who have not developed hepatic cirrhosis yet.
[Show abstract][Hide abstract] ABSTRACT: Fifty-one simultaneous pancreas-kidney transplants (SPKT) were performed between 1988 and 2004 in patients of mean age 34 years and 23 years duration of diabetes treatment. All kidney and pancreas recipients were on maintenance hemodialysis therapy prior to SPKT. The pancreas with duodenal segment and the kidneys were harvested from cadaveric heart-beating donors. Cold ischemia time in UW solution varied from 4 to 14 hours (mean, 9 hours 35 minutes). Twenty patients had the duodenal segment sutured to the urinary bladder, and the remaining 31 grafts were drained to an isolated ileal loop. Quadruple immunosuppression was administered as well as an anticoagulant and antibiotic prophylaxis. Forty-nine patients (49/51, 96%) regained insulin independence in the immediate postoperative period; 44 (86%) displayed immediate graft function. The remaining patients experienced postoperative ATN, the longest duration was 18 days. Of 51 patients, 38 (14.5%) are alive (follow-up, 6 to 180 months), 26 (68.5%) have good pancreatic function, and 34 (89%), good kidney function. Nineteen (50%) patients regard their quality of life as improved compared to their pretransplant status, which is mainly attributed to being dialysis and insulin free. Of 19 patients, 14 (74%) reported measuring glycemia regularly due to fear of losing the pancreas graft. Of 19 persons, seven (37%) returned to work after transplantation. Four (8.3%) lost their kidney graft secondary to vascular complications (n = 2) or rejection (n = 2). Four pancreas grafts with bladder drainage required conversion to enteric drainage owing to persistent urinary infections or urinary fistulae. Fifteen (29%) patients lost their pancreatic grafts within 1 year of transplantation due to the following: vascular complications (n = 12), septic complications (n = 1), or rejection (n = 2). Thirteen patients died within 1 year after transplantation, 5 of septic complications, 5 of neuroinfection, 1 of pulmonary embolism, and 2 of myocardial infarction. In conclusion, SPKT is a successful treatment for diabetic nephropathy, burdened by the possibility of serious complications.
No preview · Article · Nov 2005 · Transplantation Proceedings
[Show abstract][Hide abstract] ABSTRACT: Idiopathic portal hypertension (IPH) is diagnosed in patients with clinical symptoms of portal hypertension, patent portal vein, and the absence of morphological signs of liver cirrhosis, or when no other reason can be found for liver disease. IPH refers to a number of vaguely defined histological entities including idiopathic portal hypertension, incomplete septal cirrhosis, focal regenerative hyperplasia, and partial nodular transformation. These entities most likely belong to the spectrum of one disease, originating from the impairment of intrahepatic circulation.
A young male patient was admitted to hospital due to splenomegaly, thrombocytopenia and leucopenia. One year earlier the patient had undergone transjugular intrahepatic portocaval shunt (TIPS) due to symptoms of portal hypertension, but without effect. Liver biopsy disclosed increased fibrosis of portal areas with the penetration of a few thin streaks of connective tissue into liver parenchyma, and isolation of single nodules just under the liver capsule. There were also discrete vascular changes. Liver cirrhosis was ruled out. The patient underwent splenectomy. The spleen manifested only signs of passive hyperemia. In the follow-up 6 months after surgery there was a marked improvement of the patient's general status and normal thrombocyte level.
Splenomegaly may be the main symptom of IPH without liver cirrhosis. Histopathological assessment of liver biopsy can exclude liver cirrhosis, which has major consequences for treatment. In such patients splenectomy is usually sufficient, without the need for liver transplantation.
No preview · Article · Dec 2004 · Medical science monitor: international medical journal of experimental and clinical research
[Show abstract][Hide abstract] ABSTRACT: In this case a thyroid gland tumor was diagnosed with fine needle aspiration (FNA) in a 34-year-old female donor of a liver fragment for living related liver transplantation. This diagnosis disqualified her as a donor. The increased incidence of thyroid cancer in Poland presents the possibility of their occurrence in potential donors. Well-differentiated thyroid papillary carcinomas larger than 1 cm in diameter, as well as follicular and medullary carcinomas (regardless their size and or clinical staging), present absolute contraindication to donation. Papillary microcarcinoma restricted to the thyroid gland (with no metastases in local lymph nodes) because of its specific behavior and almost always benign course, requires an individualized approach. It seemed that when a recipient is in a life-threatening condition, we should consider taking organs from a donor suffering of papillary microcarcinoma restricted to the thyroid gland.
No preview · Article · Oct 2003 · Transplantation Proceedings
[Show abstract][Hide abstract] ABSTRACT: Vascular complications following liver transplantation is reviewed based upon literature data and our own results. Our study conclusions are mostly based on literature data, because our center does not have the liver transplantation experience of other centers worldwide. Thus, we may conclude, that the number and character of complications does not differ from those reported by other centers. The enbloc technique used in liver harvesting minimizes the risk of arterial damage in case of vascular anomalies. Recipient retransplantation is the most effective treatment method in cases of hepatic arterial occlusion. Doppler ultrasound examinations are effective to monitor vascular blood flow in the transplanted liver.
Full-text · Article · Oct 2003 · Transplantation Proceedings
[Show abstract][Hide abstract] ABSTRACT: The so-called learning factor has been disregarded for many years in analyzing the causes of surgical complications and post-operative mortality; it is also the case for OLT. In our center until April 2003, 209 OLT were performed in 196 patients. We evaluated the impact of experience of the transplantation team on the outcomes of liver transplantation. Thirty-four patients died (mortality rate, 16%) and 1-year survival rate, 64%. Mortality rates varied during different periods of observation due to increasing experience of the transplantation team. The causes of mortality were assessed for a series of 34 patients: it was 75% at the beginning of transplantation procedures while recent deaths have not recently exceeded 10% of cases.
No preview · Article · Oct 2003 · Transplantation Proceedings
[Show abstract][Hide abstract] ABSTRACT: By the end of June, 2001, 95 liver transplantations, including 7 retransplantations had been performed at the Department of General Surgery and Liver Diseases, Medical University of Warsaw. Recipients, included patients with extreme liver insufficiency who underwent surgery, on an elective and emergency basis. Aim of the study was to analyze the correlation between preliminary assessment of the acquired liver graft and its function after transplantation. Material and methods. During the mentioned period, data from 176 potential donors were obtained. These were patients treated due to hemorrhages of the CNS or following trauma. On the basis of adopted donor qualification criteria (age, ICU hospitalization, biochemical blood parameters, hemodynamic efficiency, toxicological and virusological history) organ acquisition was abandoned in 57 cases. Amongst remaining donors, livers were not collected in 11 cases due to macroscopic assessment results. Remaining 13 livers were disqualified after histopathological assessment of frozen bioptates collected during the initial phase of the procedure performed on the donor. All livers were obtained within the framework of multiorgan graft acquisition. Donors were cadavers of subjects who died at the age of 7-49 years, of both sexes, representing all main blood types. The duration of cold organ ischemia ranged between 4 and 19 hours. None of the cases required liver mass reduction, prior to transplantation. The quality of the graft was assessed macroscopically after reperfusion and following microscopic inspection of bioptates. Results. No cases of primary graft function failure were observed. The acquired liver graft was assessed on the basis of biochemical tests and amount of bile secreted during the first week. In nearly half of the recipients early graft rejection symptoms were observed, which required immunosuppressive treatment modification. In seven cases retransplantation was necessary. Conclusions. Lack of primary graft function failure cases indicates that the qualification of organs towards transplantation was correct. In doubtful cases histopathological assessment proved crucial. There are no significant correlations between the age of donors, cold ischemia period and efficiency of the transplanted organ.
[Show abstract][Hide abstract] ABSTRACT: Aim of the study was to analyse early and late results following liver transplantation, performed on 88 patients between 1989 and 2001. Material and methods. During the period between 1989 and 2001, we performed 95 liver transplantations in 88 patients. Seven patients (7.9%) were subject to retransplantation. In five cases (5.6%) transplantation was performed due to fulminant hepatic insufficiency. The study group comprised 37 male and 51 female patients. The mean patient age in these subgroups was 37.3 and 39.4 years, respectively. The most common indications towards transplantation, included primary cholestatic diseases (28 cases - 31.8%), post-inflammatory cirrhosis (22-25%) and alcoholic cirrhosis (15-17.4%). Results. In the subgroup of 83 patients subject to elective transplantations, 66 (79.5%) were discharged from the hospital in good general condition. 17 patients (20.4%) died during the first 30 postoperative days. Amongst patients subject to emergency transplantations, three patients (60%) died during the first postoperative month, while two (40%) were discharged from the hospital in good general condition. The one-year survival rate following elective surgery amounted to 86.6%, while the 3-year survival-67.5%. The longest follow-up exceeded 6 years. Conclusions. Surgical complications, infections and hemostasis disorders appear quite frequently in patients after liver transplantation. The only way to prevent long- term complications is early surgical, endoscopic or radiological intervention. Immunosuppression monitoring, prevention of its side effects, diagnostics of viral hepatotropic infections and recurrence of primary liver diseases are required to improve long -term survival in these patients.
No preview · Article · Apr 2002 · Transplantation Proceedings
[Show abstract][Hide abstract] ABSTRACT: Aim of the study was to analyse early and distant liver transplantation results on the basis of our own material. Material and methods. During the period between 1989 and 2001, 104 orthotopic liver transplantations in 97 patients were performed at our Department. Indications for liver retransplantation were defined in 10 cases, including hepatic artery thrombosis (HAT) in 6, biliary complications in 2, recurrent acute graft rejections resistant towards pharmacological treatment in one female patient and primary liver non-function in one female patient. Results. Retransplantation of the liver was performed in 7 patients (7.2%). In three cases, including one female patient with hepatic artery thrombosis, one with primary non-function and one female patient with acute rejection despite urgent indications, liver transplantations were not conducted due to lack of suitable organs for surgery. Patients were divided into two groups, depending on liver retransplantation indications: 1) patients with hepatic artery thrombosis, in whom surgery was regarded as an emergency procedure, 2) patients with biliary complications, in whom retransplantation may be considered elective. Early good results were observed in 7 patients (100%) - in 4 with HAT and in 2 with biliary complications. One female patient with HAT died 7 days after ReOLTx due to hemorrhagic diathesis. Satisfactory distant results were observed in 5 patients (71%), three group land two group 2 patients. One female patien t with HAT despite good immediate results, died 3 months after ReOLTx due to late septic complications. Conclusions. 1. Liver transplantation remains the only effective method of treatment in case of irreversible graft damage. 2. Treatment results largely depend on indications towards transplantation. 3. Retransplantation can be an elective procedure in case of biliary tree damage. On the contrary, retransplantation in HAT is of urgent nature. 4. Late retransplantation results in patients with biliary complications are good. In patients with HAT late results depend on the expected time of retransplantation.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine a correlation between the haemodynamics of portal collateral circulation (PCC) and the incidence of bleeding episodes. The prospective analysis included 17 patients with portal hypertension resulting from prehepatic block but without history of oesophageal bleeding. Every two months the changes in PCC and incidence of oesophageal bleeding were evaluated. The follow-up ranged from 3 to 12 months. The statistical correlation between the portal haemodynamic disorders and the tendency to bleed was investigated. Variceal bleeding occurred in 6 patients during the time of observation, mostly in patients with development of hepatofugal PCC. Authors suggest that the development of hepatofugal PCC is the main factor of variceal bleeding in patients with portal vein thrombosis (PVT).
No preview · Article · Jun 2001 · Medical science monitor: international medical journal of experimental and clinical research
[Show abstract][Hide abstract] ABSTRACT: The aim of the paper is to present the role of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension complications such as variceal bleeding and persistent ascites.
Between June 1992 and December 2000, 56 patients with portal hypertension developed in the course of hepatic cirrhosis were qualified for TIPS. The indications for TIPS included esophageal variceal bleeding, recurrent despite endoscopic treatment (N-40), active esophageal variceal hemorrhages in which traditional methods used to stop the bleeding proved ineffective (N-8) and ascites failing to respond to high doses of diuretic agents (N-8). The studied group consisted of 30 females and 26 male patients aged from 17 to 68 (mean age 52 yrs). According to Child-Pugh surgical risk classification, 26 patients belonged to group B, and 30 to group C.
In 50 patients (83.5%) an intrahepatic shunt was formed and the stent(s) implanted. In 42 cases (75%), long-lasting patency of the shunt was obtained and esophageal variceal bleeding was stopped. Active esophageal variceal hemorrhages were stopped in all the cases. The remission of massive ascites and hepatorenal syndrome was obtained in 7 out of 8 patients.
TIPS is a non-surgical method relieving portal hypertension in patients with variceal hemorrhages recurrent despite endoscopic treatment. Very good results were also obtained in the cases with active variceal hemorrhages. TIPS has proved to be an effective method of treatment in the patients with massive ascites and hepatorenal syndrome.
No preview · Article · Jun 2001 · Medical science monitor: international medical journal of experimental and clinical research