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Abstract: Aim: The objective was to identify the major prognostic factors influencing liver function after transplantation that predict the postoperative course and long-term survival among liver transplant recipients. We analyzed the results of biochemical, microbiological, serologic, and pathologic studies of the donor and recipient, as well as intraoperative data. Materials and methods: Of 542 liver transplant recipients, 215 (39.7%) were analyzed in the period from 1989 to 2006. Patients were divided according to the mechanism leading to the liver disease: group I, hepatitis C virus (HCV) infection (n = 80, 37.0%); group II, hepatitis B virus (HBV) infection (n = 33, 15.0%); group III, HBV and HCV infection (n = 13, 6.0%); group IV, alcoholic liver disease (ALD) (n = 66, 31.0%); and group V, autoimmune hepatitis (AIH) (n = 23, 11.0%). Results: Prediction of patient survival based on clinical parameters showed a better prognostic value than that based only on liver function tests. Transplant urgency scores—Model for End-Stage Liver Disease (MELD), delta MELD and United Network for Organ Sharing (UNOS)—enabled us to predict early and long-term patient survival after liver transplantation. Update of these scores, reflecting the patient''s condition, enabled us to evaluate pretransplant life-threatening factors and urgency level. Organ donation predictive factors were age, viral status, and degree of liver steatosis. Cold and warm ischemia times still were major prognostic factor. Routine biliary drainage resulted in worse long-term survival than non-drained patients. Liver transplantation for ALD showed the highest complication rate. Chronic liver rejection occurred more frequently in the AIH transplanted group. The most useful predictive factors for 1-year survival were urea/creatinine and liver function tests: aspartate and alanine aminotransferases, γ-glutamyl transpeptidase the International normalized ratio, and Quick. Conclusion: The prognosis of patient outcomes after liver transplantation based on clinical parameters showed greater value than evaluation of the laboratory data. [Copyright &y& Elsevier]

Abstract: Background: Living-related liver transplantation for pediatric patients has become an acceptable, low-risk treatment option. The aim of this study was to assess the extent of donor liver regeneration. Materials and Methods: Between October 1999 and January 2008, 120 living-related donors provided 109 grafts consisting of segments II and III and 11 grafts consisting of segments II, III, and IV. Volumetric assessment of the donor liver and selected segments was performed using computed tomography. After procurement every graft was weighed. At 7 and 30 days, as well as 12 months after the operation the donor liver remnant was evaluated for differences in volume. Results: A significant correlation was observed between the liver graft mass and its volume as assessed by computed tomography (r = 0.781; P < .05). Twelve months after procurement, the average regeneration index was significantly higher among donors of segments II, III, and IV (144 ± 23%) versus donors of segments II and III (114 ± 15%; P < .05). Conclusion: Liver regeneration after procurement of selected liver segments from living donors is a consistent finding. Computed tomography is an accurate imaging modality to track changes in liver volume. This study showed a positive correlation between the size of the liver graft and the regeneration of the liver remnant in the donor. [Copyright &y& Elsevier]

Abstract: Biliary complications are known as a weak point of liver transplantation. Their occurence can be related to the practice of draining the biliary anastomosis performed at the time of transplantation. At our institution, routine of anastomotic biliary drainage was abandoned in June 2004. Aim: We sought to assess the occurence and character of biliary complications following orthotopic liver transplantation in relation to the technique of anastomosis. Materials and Methods: In two groups of transplantees: last 100 transplantations with biliary drainage (48 females and 52 males aged 17 to 64 years) and last 100 transplantations without drainage (52 females and 48 males aged 18 to 67 years). The results of treatment were compared, for biliary complications and their influence on further management. In both groups, the main indications for transplantation were various types of cirrhosis as well as cholestatic diseases. In most cases (167) we performed a cholangiojejunal Roux-en-Y (CBD) end-to-end anastomosis, less commonly (33 cases) hepaticojejunal anstomoses. Results: In the first group, biliary complications (bile leak at the site of drainage, bile leak after T-tube removal, CBD strictures) requiring surgical or endoscopic intervention, occurred in 17% recipients. In one case, the biliary complication resulted in retransplantation. In the second group, biliary complications occured in 11% patients. None of them caused organ loss. Conclusion: Abandoning drainage of the biliary anastomosis has reduced the occurrence of early biliary complications after orthotopic liver transplantation. [Copyright &y& Elsevier]

Abstract: Introduction: Biliary complications are known as the weak point of liver transplantation. Their occurrence can be related to the practice of drainage of the biliary anastomosis, the routine use of which was abandoned in June 2004. The aim of the study was to assess the incidence and type of biliary complications following orthotopic liver transplantation in relation to the technique of biliary anastomosis. Material and methods: We compared the results of two groups of adult liver transplant recipients: group I, recent 50 transplantations with biliary drainage (25 women: 25 men of age range: 17 to 63 years), and group II, first 50 transplantations without drainage (19 women and 31 men of age range, 20 to 65 years). We examined the problem of biliary complications and their influence on the further management of the patients. In both groups the main indications for transplantation were various types of cirrhosis as well as cholestatic diseases. In the majority of cases (n = 86) an end-to-end common bile duct anastomosis was performed and in 14 cases, hepaticojejunal anastomosis. Results: In group I, biliary complications requiring surgical or endoscopic intervention occurred in 10 (20%) recipients. In one case, biliary complications resulted in the need for retransplantation. In group II, biliary complications occurred in only four (8%) patients, none of which caused organ loss. Conclusion: Cessation of biliary anastomosis drainage has reduced the occurrence of early biliary complications following orthotopic liver transplantation. [Copyright &y& Elsevier]

Abstract: Introduction: We compared early results of orthotopic liver transplantation (OLT) in adults using the classic versus piggyback technique of inferior vena cava anastomosis. Patients and Methods: We analyzed 100 consecutive patients who underwent OLT from 2000 to 2003. Group A included 50 patients operated with the classic technique with venovenous extracorporeal bypass, and group B, 50 patients with the piggyback technique. The age range of the patients in group A was 21 to 63 years (mean, 43.5 years) and in group B, 20 to 65 years (mean, 46 years). The gender F/M distribution in group A was 24/26 and in group B, 28/22. The indications for OLT were acute hepatic failure (8%), chronic liver insufficiency (77%), liver tumors (8%), metabolic diseases (5%), and Budd-Chiari syndrome (2%). The degrees of liver insufficiency evaluated according to the Child classification were A, 18; B, 52; and C, 30 patients. The urgency for OLT on the United Network for Organ Sharing (UNOS) scale was UNOS 1—group A, 2 patients; group B, 7 patients; UNOS 2a—group A, 7 patients; group B, 6 patients; UNOS 2b—group A, 29 patients; group B, 30 patients; UNOS 3—group A, 12 patients; group B, 7 patients. Results: The average cold ischemia time in group A was 530 minutes and in group B, 515 minutes. The average results on the 10th postoperative day: aspartate transaminase (AST)—group A, 52.5 U/L; group B, 54.5 U/L; alanine transaminase (ALT)—group A, 131.5 U/L; group B, 153 U/L; gamma glutyl transpeptidase (GGTP)—group A, 299 U/L; group B, 285.5 U/L; alkaline phosphatase (ALP)—group A, 164 U/L; group B, 150.5 U/L; bilirubin—group A, 4.37 mg%; group B, 2.71 mg%; activated partial thromboplastin time (APTT)—group A, 37.6 seconds; group B, 34.8 seconds; platelets (PLT)—group A, 167 102/mm2; group B, 171 102/mm2. The incidence of postoperative complications was 36% in group A; it was 30% in group B. The mean hospitalization times in the surgical department were 17 days in group A and 16 days in group B. Conclusions: The early results, morbidity and mortality with both applied techniques were similar. Individualization in qualifying the patients for a given operative technique is important. The lower complication rate and reduced treatment cost of the piggyback technique group suggested advantages of this technique when compared with the classical OLT technique. [Copyright &y& Elsevier]

The authors present an analysis of early and remote liver transplantation outcomes related to the presence of emergent indications among 196 of the 209 operations performed from 1989 to April 2003; namely 178 elective and 18 emergent transplantations. Perioperative mortality was 15%. The survival rate during the first 12 months was 79.8% and within 3 years 73.5% among patients operated on an elective basis (UNOS 3 and 2B). In contrast, patients with acute liver failure (UNOS 1 and 2A) showed rates of 45%, 50%, and 47%, respectively. Liver transplant outcomes depend primarily on the urgency of an operation. Longterm results are much better among patients operated on electively. Liver transplantation in patients with acute hepatic insufficiency is burdened with a high 45% mortality. [Copyright &y& Elsevier]

Chirurgiczna resekcja pierwotnych i przerzutowych zmian ogniskowych w wątrobie jest optymalnym sposobem leczenia tej grupy chorych, jednakże u większości pacjentów - ok. 80% - radykalne onkologicznie R0 resekcje będą niemożliwe. W związku z nowymi możliwościami terapeutycznymi, które pojawiły się wraz z postępem technologicznym i farmakologicznym, coraz większej grupie chorych można zaproponować metody leczenia o charakterze paliatywnym, ale w istotny sposób poprawiające przeżycie i komfort życia. Wyjaśnienie, czy techniki ablacyjne są choć porównywalne do chirurgicznego wycięcia resekcyjnych zmian pierwotnych i przerzutowych w wątrobie oraz czy techniki te dają dodatkową korzyść w postaci wydłużenia okresu przeżycia w stosunku do współczesnego leczenia chemicznego nieresekcyjnych zmian, wciąż wymaga przeprowadzenia randomizowanych badań klinicznych. Postęp technologiczny jest skoncentrowany na doskonaleniu coraz potężniejszych narzędzi wykorzystujących elektrolityczne lub mikrofalowe sposoby destrukcji zmian ogniskowych. W opublikowanej w 2015 roku pracy będącej przeglądem ablacyjnych i embolizacyjnych technik stosowanych w leczeniu wtórnych zmian ogniskowych I poziom ewidencji (AHRQ) osiągnęły termoablacja RFA oraz dotętnicza chemioterapia irinotekanem (PVA DEBIRI) i radioembolizacja (SIRT). Radioembolizacja glass SIRT oraz termoablacja mikrofalowa osiągnęły II/III poziom, natomiast krioablację i nieodwracalną elektroporację czyli NanoKnife sklasyfikowano na poziomie IV. Nieco inaczej wygląda rola technik ablacyjnych w terapii pierwotnych nowotworów złośliwych wątroby. U chorych z HCC optymalnym leczeniem, przy zachowaniu restrykcyjnych kryteriów, jest transplantacja wątroby bądź ograniczona resekcja. Termoablacja (RFA/MWA) oraz TACE mogą być terapią pomostową do transplantacji bądź metodami leczenia wznowy guza albo formą leczenia paliatywnego. W grupie pacjentów z nieresekcyjnym wewnątrzwątrobowym cholangiocarcinoma techniki destrukcji guza są daleko mniej skuteczne i zazwyczaj nie poprawiają odległego przeżycia chorych. Współcześnie zabiegi z zakresu radiologii interwencyjnej mogą stanowić uzupełnienie leczenia chirurgicznego chorych z pierwotnymi i przerzutowymi nowotworami wątroby. [ABSTRACT FROM AUTHOR]

Abstract Introduction Prostate cancer has become an important clinical issue within deceased organ donors. There is still a considerable number of undiagnosed cancers, especially in early stage, despite frozen section analysis. The aim of the study was to evaluate outcomes of orthotopic liver transplants (OLTx) with organs from donors with prostate cancer. Material and Methods A retrospective analysis was performed in deceased liver donors whose prostate glands were harvested for histologic examinations because of prostate cancer suspicion. The study group consisted of 72 men reported as potential liver donors between 2011 and November 2017. Prostate glands were primarily assessed by frozen sections and afterward in routine examination. Generally cancer diagnosed in frozen specimen was not considered for OLTx. Recipients who received an organ from the donor with prostate cancer were actively surveilled. Results There were 19 cases (26.40%) of prostate cancer diagnosed among the study group. In 12 cases diagnosis was made by frozen section assessment, of which 11 organs were disqualified from OLTx and 1 was transplanted. In 7 cases prostate cancer was diagnosed after OLTx in final routine histologic examination. Finally, 8 recipients (5 men and 3 women) received a new organ. Only 1 died during the perioperative period. In the remaining 7 patients the perioperative period was uneventful and no disease transmission was observed during follow-up. Conclusions Diagnosis of prostate cancer in donors should not be treated as a contraindication for OLTx because the risk of disease transmission is low. Potential recipients must be fully informed and kept under oncological surveillance. Highlights • Eligibility of donors diagnosed as having prostate cancer is proposed to expand the donor organ pool. • No disease progression and cancer-related death was observed among liver transplant recipients. • Use of organs from donors diagnosed as having prostate cancer should not be avoided, but recipients must be put on active surveillance. [ABSTRACT FROM AUTHOR]

Abstract: Background: Computerized tomography–assisted volumetry permits one to estimate the volume of the liver graft as well as to monitor the regeneration in the donor for living- related liver transplantation (LRLT). Methods: The size of the whole liver and of the segments II, III, and IV was assessed in 64 living-related liver donors by preoperative computerized tomography (CT) volumetry. Segments II and III were harvested in 56 cases; segments II, III, and IV in 8 cases. The remnant liver was assessed by CT volumetry on postoperative days 7 and 30. Results: There was a linear correlation between the calculated volume of the graft and its weight (R = 0.61, P < .04). Postoperative CT volumetry of the liver from a living-related donor showed a different pattern of volume restoration (regeneration index) both at 7 and 30 days among donors who sacrificed segments II and III versus segments II, III, and IV. The mean regeneration indices were significantly higher among donors of segments II, III, and IV compared with donors of segments II and III after 7 and 30 days (P < .05). Discussion: It is possible that the donor liver displays a different pattern of growth due to the alteration in the blood supply to segment IV. [Copyright &y& Elsevier]

Abstract: Epithelioid hemangioendothelioma (EHE) is a rare neoplasm of vascular origin, but unknown etiology that occurs in the liver, lungs and other organs. Its hepatic form (HEHE) generally behaves as a low-grade malignant tumor with a slowly progressive phenotype. Surgical resection or liver transplantation (OLT) has been recommended after diagnosis. We present a 30-year-old woman with primary HEHE of the liver treated by OLT in 2002. Her medical history started 3 years prior when an abdominal ultrasound examination revealed multiple focal changes in the liver. The histopathological diagnosis from a needle biopsy was carcinoma cholangiogenes desmoplasticum. For 2 years the patient was treated with chemotherapy combinations. To explain the lack of efficacy of chemotherapy, a laparoscopic biopsy was performed and HEHE diagnosed. Immunohistochemistry revealed positive staining for the factor VIII–related antigens, CD34 and CD31, which have been previously described as HEHE markers. The patient underwent OLT in March 2002. In the first month after OLT, the thyroid stimulating hormone concentration was elevated but they continuously decreased from 11.4 to 2.4 uIU/mL in May 2002 and thereafter remains normal. After 3 years observation the patient presented with good liver function and no signs of tumor recurrence. We concluded that immunohistochemical staining for characteristic endothelial cell markers may facilitate the correct diagnosis of HEHE. After diagnosis, OLT followed by immunosuppressive therapy, consisting of basiliximab, corticoids, low doses of tacrolimus and temporary administration of rapamycin, may be safe and effective. Monitoring of thyroid-stimulating hormone concentrations should be performed in patients with HEHE. [Copyright &y& Elsevier]

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. [Copyright &y& Elsevier]

Abstract Background Cardiovascular events (CVE) contribute to serious complications and death after liver transplantation (LT). Troponin I (TnI) level >0.07 mg/L and prior cardiac disease are known to be the independent predictors for posttransplant CVE. We evaluated single-center cardiac workup to predict early cardiovascular morbidity and mortality after LT. Patients and methods We recruited 105 consecutive liver transplant recipients (male/female, 59/46; mean age, 51.66 ± 11.67 years). The cardiological assessment at evaluation for LT included medical history, electrocardiogram, echocardiography, Holter monitoring, and exercise test. We collected data regarding CVE including hypotonia with catecholamine usage, arrhythmia, sudden cardiac death, pulmonary edema, and myocardial infarction within 7 days after LT. Results CVE during LT occurred in 42 recipients (40%) and after LT in 9 patients (8.57%). Proposed cutoff level of TnI >0.07 mg/L did not correlate with CVE during operation (P =.73) or after LT (P =.47). CVE during LT was associated with arterial hypertension in medical history (P <.001), right ventricular systolic pressure (P <.05), and clinical scores: Child-Pugh (P =.04), Model for End-Stage Liver Disease (MELD) (P =.04), MELD incorporating serum sodium (P <.03), and integrated MELD score (P =.01). CVE after LT correlated only with arrhythmia (P <.001) and catecholamine usage (P <.05) perioperatively. Of interest, catecholamine usage during LT was associated with prolonged stay at the intensive care unit (P <.05). Conclusion The single-center algorithm with noninvasive cardiac procedures without TnI assessment is optimal in evaluation before LT; however, medical history and severity of the liver disease are crucial for short-term cardiovascular morbidity after LT. Highlights • Cardiovascular events (CVE) contribute to morbidity after liver transplantation (LT). • CVE during LT is associated with hypertension and right ventricular function. • Perioperative arrhythmias are predictors of CVE within 7 days after LT. • Medical history and liver disease severity are crucial for cardiac morbidity after LT. [ABSTRACT FROM AUTHOR]

Abstract Background Despite worldwide debate on optimal selection of patients with hepatocellular carcinoma (HCC) for liver transplantation, the Milan criteria remain the benchmark for comparisons. Moreover, morphologic tumor features are universally considered important in pretransplant patient evaluation. The aim of this study was to establish the diagnostic accuracy of multiphasic computed tomography (CT) in assessing HCC burden before liver transplantation with special reference to Milan criteria fulfillment. Methods This retrospective study was based on a data from 27 HCC patients after liver transplantation with available CT performed within 30 days pretransplant. CT results were compared with explant pathology with respect to Milan criteria fulfillment, tumor number, and diameter of the largest tumor. Results Out of 19 patients within the Milan criteria on CT, 3 fell beyond the criteria on explant pathology with a gross underestimation rate of 15.8%. Out of 8 patients beyond the Milan criteria on CT, 3 were within the criteria on explant pathology with a gross overestimation rate of 37.5%. Regarding tumor number, CT was accurate only in 14 patients (51.9%), while overestimation and underestimation occurred in 5 (18.5%) and 8 (29.6%) patients, respectively. Overestimation and underestimation of largest tumor size by at least 1 cm occurred in 4 (14.8%) and 7 (25.9%) patients, respectively. Discussion Multiphasic CT is associated with a remarkable risk of both under- and overestimation of HCC burden before transplantation. Transplant eligibility should not be solely based on CT results. Highlights • CT over- and underestimated Milan status in 37.5% and 15.8% of cases, respectively, in this study. • CT over- and underestimated HCC number in 18.5% and 29.6% of patients, respectively. • CT over- and underestimated HCC size in 25.9% and 14.8% of patients, respectively. [ABSTRACT FROM AUTHOR]

Abstract Background Prolonged initial intensive care unit (ICU) stay after liver transplantation (LT) is associated with prolonged total hospitalization, increased hospital mortality, and impaired patient and graft survival. Recent data suggested that model for end-stage liver disease (MELD) score at the time of LT and the length of surgery were the two independent risk factors for an ICU stay longer than 3 days after LT. We further identified factors influencing prolonged ICU stay in single-center liver graft recipients. Patients and methods One hundred fifty consecutive LT recipients (M/F 94/56, median age 55 (range, 39–60), 36% with viral hepatitis, were prospectively enrolled into the study. Associations between clinical factors and prolonged ICU stay were evaluated using logistic regression models. Receiver operating characteristic curves were analyzed to determine the appropriate cutoffs for continuous variables. Threshold for significance was P ≤.05. Results Highly prolonged (≥8 days) and moderately prolonged (≥6 days) postoperative ICU stay was noted in 19 (12.7%) and 59 (39.3%) patients, respectively. Serum bilirubin (P =.001) and creatinine concentrations (P =.011), international normalized ratio (P =.004), and sodium-MELD (P <.001) were all significantly associated with postoperative intensive care unit stay over or equal to 75th percentile (6 days). Sodium-MELD was significantly associated with postoperative care unit stay greater or equal to the 90th percentile (8 days; P =.018). Conclusions Sodium-MELD might be a novel risk factor of prolonged ICU stay in this single-center experience. Highlights • Sodium-MELD and its components are associated with moderately prolonged ICU stay after LT. • Only sodium-MELD is associated with highly prolonged ICU stay (≥8 days) after LT. • Pretransplant sodium-MELD ≥ 23 points carries a 75% risk of prolonged postoperative ICU stay. [ABSTRACT FROM AUTHOR]

Abstract Background Cardiovascular events (CVE) might occur in 20% to 70% of liver transplant recipients, and major CVE are associated with poor long-term survival. Overall, the ability to identify patients at the highest risk of death after liver transplantation (LT) has been improved. Abnormal pretransplant troponin I (TnI) level is regarded as one of predictors of postoperative CVE. We evaluated the number of early CVE after LT and the impact of pretransplant TnI on cardiovascular morbidity. Patients and methods We prospectively enrolled 110 consecutive liver transplant recipients (M/F 67/43, age 53.3 ± 10.4 years, 32.7% with hepatitis C virus). Seven of them (6.4%) were on urgent protocol and 3 patients (2.7%) had re-LT. TnI level was measured at listing for LT and directly after LT; clinical outcomes were observed within the first 7 days after LT. Results CVE during LT occurred in 51 recipients (46.4%). CVE after LT at the intensive care unit were noticed in 13 patients (11.8%). One patient (0.9%) died in the first 7 days after LT. The level of TnI >0.07 did not correlate with CVE during operation and 7 days after LT (P >.05), but the subgroup with TnI >0.07 before LT had a trend with higher TnI after LT (P =.065). Recipients with hepatitis C virus had a trend for higher TnI after LT (P =.061). CVE directly after LT correlated significantly with Child-Pugh (P =.01), Model for End-Stage Liver Disease (MELD), MELD incorporating serum sodium, and integrated MELD scales (P <.001). Conclusion In our single-center algorithm, TnI with canonical cutoff value of 0.07 was not an effective predictor for cardiac outcomes shortly after LT in our population. Highlights • Cardiovascular events (CVEs) frequently occur during liver transplantation (LT). • CVE directly after LT correlates with severity of liver disease. • Canonical cutoff value of TnI >0.07 is not an effective predictor for CVE during LT. • TnI with cutoff value of 0.07 cannot help predict CVE shortly after LT. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents the results of liver transplantation for fulminant hepatic failure in 31 patients qualified as UNOS-1 class (extra-urgent indication for transplantation), operated from January 1989 to April 2005. Twenty-one patients (61.8%) survived the 3-month postoperative period. Three-year survival rate with good liver graft function was 52.9% (18 patients). Before the transplantation, eight patients (23.5%) underwent hepatic dialysis using Fractionated Plasma Separation and Adsorption (FPSA) with the use of a Prometheus 4008H System. Liver transplantation remains the only life-saving procedure for the treatment of fulminant liver failure, regardless of its cause. [Copyright &y& Elsevier]

Background Echinococcosis is a zoonosis caused by infestation with any of 4 (of the 16) members of the Echinococcus genus, namely Echinococcus granulosus, Echinococcus multilocularis, Echinococcus oligarthus, and Echinococcus vogelii. The aim of this retrospective analysis was to present the outcomes of patients undergoing liver resection and liver transplantation ( LT) for E. multilocularis infection. Methods A total of 44 patients who underwent surgical treatment of E. multilocularis infection in the period between 1989 and 2014 were included in the study cohort and retrospectively analyzed. Results LT was performed in 22 patients (50.0%), including 4 of 26 patients undergoing initial non-transplant management. Non-transplant procedures comprised liver resection in 23 patients (88.5%), diagnostic laparoscopy in 2 (7.7%), and left adrenalectomy in 1 patient (3.8%). Post-transplantation survival rates were 90%, 85%, and 75% at 1, 5, and 10 years, respectively. Conclusion In conclusion, LT for E. multilocularis infection is a safe and effective treatment method. [ABSTRACT FROM AUTHOR]

: IntroductionBiliary tract complications, which occur in 5.8% to 24.5% of adult liver transplant recipients, remain one of the most common problems following transplantation. The aim of this study was to evaluate these problems and analyze methods of treatment.: Material and methodsFrom 1989 to 2003, 36 (18.7%) among 193 patients who underwent orthotopic liver transplantations in our center developed biliary complications. Biliary strictures that developed in 18 cases (9.3%) were the most common complications. Clinical manifestations of strictures developed at 2 to 24 months after transplantation. Bile leaks occurred in 10 patients (5.2%), and were diagnosed in along the T-tube 4 cases and was not accompanied by any clinical manifestation. Bile leak to the peritoneum after T-tube removal occurred in 2 patients (1.1%). Solitary gallstone formation in one case (0.5%) was removed with the use of ECPW. One patient required retransplantation within 3 months after transplantation, because of the most severe complication—ischemic necrosis of biliary tract.: ResultsUneventful recovery was achieved in 34 patients in the analyzed group (94.4%). There was no case of recurrence during outpatient follow up. Two patients died in late follow-up of unrelated causes: namely, gastrointestinal bleeding due to a duodenal ulcer and multi-organ failure (MOF) due to a third severe episode of acute liver transplant rejection.: ConclusionsBiliary complications remain an important problem in liver transplantation. Endoscopic and radiologic management are effective in the majority of cases. Surgical intervention is obligatory in selected cases. [Copyright &y& Elsevier]

The aim of this paper was to present anatomic variations of bile ducts and their effect on the perioperative course of living-related donors in partial liver transplantations in children. Liver fragments for partial transplantation were harvested from 41 related donors. Segments II and III were harvested from 35 and segments II, III, and IV from 6 donors. During the procedure, cholangiography through cystic duct was performed revealing a normal anatomy of the bile ducts in 33 (80.5%) cases. The rest of the donors showed anatomic variations. There was only one case of complications related to the bile duct. The intraoperative diagnosis of anatomic variations allowed for safe partial liver harvesting. [Copyright &y& Elsevier]

Abstract Background Hepatic artery thrombosis (HAT) is one of the most severe complications after liver transplantation (LT). HAT can lead to early graft loss and retransplantation or death of the recipient. Methods This retrospective cohort study was conducted using data from patients treated between January 2008 and December 2013 in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw. A total of 750 patients underwent LT over this period. Results HAT occurred in 27 patients (2.1%). The median DRI was 1.414 (IQR 1.103–1.578) points and median donor age was 47 (IQR 33–56) years. The optimal cut-off value of DRI in predicting HAT was ≥1.328 points. The cutoff point was characterized by sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 88.0%, 41.3%, 5.5% and 98.9%, respectively (AUC = 0.605, 95% CI 0.477–0.733). A DRI ≥1.328 was a significant risk factor for HAT (OR = 5.16, 95% confidence interval [CI] 1.529–17.48, P =.008). The optimal cutoff point for donor age was 50 years and was characterized by sensitivity, specificity, PPV, and NPV of 66.7%, 55.8%, 5.3%, and 97.8%, respectively. Donor age ≥50 years (OR = 2.53, 95% CI 1.123–5.714, P =.025) was a significant risk factor for HAT. Conclusion DRI is a clinically relevant factor that allows estimating the risk of HAT after liver transplantation from a deceased donor. To reduce the incidence of this complication, the allocation of organs taken from donors at DRI exceeding 1.328 for recipients without other HAT risk factors should be considered. Highlights • DRI is a clinically relevant factor that allows estimating the risk of HAT after liver transplantation from a deceased donor. • To reduce the incidence of HAT, the allocation of organs taken from donors at DRI exceeding 1.328 for recipients without other HAT risk factors should be considered. • Donor age compared with the DRI is worse parameter to predict the occurrence of HAT after LT. [ABSTRACT FROM AUTHOR]

Introduction Faced with a shortage of organs for liver transplantation, the use of grafts from older donors is justified. However, there remains little consensus on how this use impacts the graft and patient outcomes after transplantation from these older donors. The aim of the present analysis was to assess the graft and patient outcomes after liver transplantation from deceased donors >60 years of age. Methods From January 2007 to January 2011, 505 subjects were identified as liver graft donors after brain death, of which 7.35% were ≥60. To determine the effect of donor age on graft and patient outcomes, we analyzed donor age, recipient age, the Model for End-State Liver Disease (MELD) score of recipients at the time of transplantation, early posttransplant complications, and mortality. Results The posttransplant follow-up was 29 ± 25.5 months, and 3-year patient mortality from donors, grouped according to age, was 7.92% with donors <30; 15.78% with donors 30–50, 10.68% with donors 50–60, and 12.50% with donors >60. After analysis of patient and graft survival based on donor graft age, 3-year patient survival according donor age was 89.29% with donors <30, 83.85% with donors 30–50, 89.89% with donors 50–60, and 87.50% with donors >60. Analysis showed overall patient and graft survival rates from older donors were not worse than those from younger donors ( P > .1). Among the cases, 3-year patient survival according to MELD score was 91.19% with a MELD of I, 85.37% with a MELD of II, and 67.67% with a MELD of III; differences in graft and patient survival when comparing low MELD I and high MELD III were significantly different ( P < .01). Conclusions A more advanced age of a donor should not be a contraindication for liver transplantation. The present analysis shows that liver grafts from donors >60 can be used safely in older recipients who presented with relatively low MELD scores. Analyses also indicate that high MELD obtained before transplantation may be an important prognostic factor for graft and patient survival. [ABSTRACT FROM AUTHOR]

Background Acute renal failure (ARF) is one of the most significant complications of orthotopic liver transplantation (OLT), associated with increased mortality rate and the development of chronic renal dysfunction. The aim of the study was to determine the perioperative risk factors for ARF in patients without previous history of renal disease who are undergoing OLT. Materials and methods Forty-six patients who developed ARF after OLT performed in 1 transplant center were included in the study, and 52 consecutive patients without that complication served as a control group. Renal dysfunction was defined as a glomerular filtration rate <60 mL/min/1.73 m 2 . The data concerning preoperative diseases, perioperative renal function, first-line immunosuppressive therapy, and blood transfusion requirement were retrospectively analyzed and compared among groups. Logistic regression modeling was used to determine risk factors for ARF. Results Patients who developed ARF were significantly older (mean age 53.3 vs 46.3 years, P = .057), had higher level of preoperative (0.79 vs 0.71 mg/dL, P = .0062) and intraoperative (0.85 vs 0.74 mg/dL, P = .0045) creatinine. The risk factors for ARF were intraoperative and 24-hour post-transplant creatinine level >0.9 mg/dL and high-dose tacrolimus-based immunosuppression. Transfusion of ≤6 units of red blood cells diminished the risk of ARF. Sex and preoperative diseases were not predictive to ARF in our regression models. Conclusion Careful operative technique with low blood loss and immunosuppressive therapy of low nephrotoxic potential should be recommended in older patients to diminish the risk of renal dysfunction after orthotopic liver transplantation. Patients with higher levels of perioperative creatinine should be considered to have first-line immunosuppression without calcineurin inhibitors or with low-dose immunosuppressants of known nephrotoxic potential. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Appropriate selection of hepatocellular cancer (HCC) patients for liver transplantation is crucial to minimize the risk of recurrence and provide long-term outcomes comparable with those for other indications. Selection criteria based on total tumor volume (TTV) and α-fetoprotein (AFP) concentrations were proposed in a recent large study. The aim of this study was to evaluate the results of liver transplantation for HCC within and beyond these criteria. Material and Methods: This retrospective study included 104 patients with HCC who underwent liver transplantation. Risk factors for overall survival and tumor recurrence were evaluated. Overall survival and cumulative tumor recurrence rate for patients with TTV <115 cm3, AFP concentration <400 ng/mL, and no macrovascular invasion (76/104; 73.1%) were evaluated and compared with those for the remaining patients (28/104; 26.9%). Results: Pretransplantation AFP concentration >400 ng/mL (P = .016; hazard ratio [HR], 3.36; 95% confidence intervals [CI], 1.25–9.03) was the only risk factor for overall survival. TTV >115 cm3 (P = .021; HR 4.29; 95% CI, 1.24–14.81) and AFP concentration >400 ng/mL (P = .002; HR 6.97; 95% CI, 2.02–24.03) were independent risk factors for recurrence. The estimated 3-year tumor recurrence rate was 4.2% for patients with TTV <115 cm3, AFP concentration <400 ng/mL, and no macrovascular invasion compared with 57.2% for the remaining patients (P < .00001). The 3-year overall survival rate of patients within and beyond this criteria was 81.7% and 64.6%, respectively (P = .0628). Conclusions: In contrast to other criteria, selection of HCC patients for liver transplantation on the basis of TTV and AFP concentration relates to both morphological features and tumor biology. Although fulfillment of these criteria was more than 1.5-fold higher than that of the Milan criteria, the rate of tumor recurrence was exceptionally low. [Copyright &y& Elsevier]

Abstract: Introduction: Liver transplantations give female recipients an ability to carry pregnancies successfully. However, solid organ transplantations exacerbate the pregnancy including maternal and neonatal outcomes. The aim of our study was to evaluate and identify the obstetric outcomes in women with a prior liver transplantation. Methods: We analyzed all pregnant woman who had undergone a prior liver transplantation and afterward delivered from 2001 to 2011. Complete data were assessed in 39 deliveries and 40 live births. Three women were pregnant twice after liver transplantation. Results: The mean gestational age at birth measured 37.2 ± 2.2 weeks. The most common obstetric complications were premature labor (12/39,30.8%), hypertension (10/39, 25.6%), and symptomatic urinary tract infections (7/39, 18%). Other complications were pregestational diabetes (n = 1), cholestasis (n = 3), and of severe anemia treated with blood transfusions (n = 2). The mean time from organ transplantation to delivery was 67.6 ± 47.2 months. Acute graft rejections occurred among pregnant women 7.7% (3/39) of studied. Only 8 (20.5%) deliveries were finished vaginally. Infants small for gestational age were diagnosed in 20% (8/40). One case displayed a congenital urinary tract malformation. None of the neonates died neonatally. Conclusions: Pregnancies are possible after liver transplantation and likely end with successful maternal and newborn outcomes. Some cases experience an increased risk of obstetric complications. Therefore, posttransplant pregnancies must be regularly monitored with a multidisciplinary approach. [Copyright &y& Elsevier]

Abstract: Objective: The aim of this study was to examine the survival of adult liver retransplant recipients depending on selected factors: time from the primary transplantation, cold ischemia time, indications for retransplantation, patient age and United Network for Organ Sharing (UNOS) status. Patients and Methods: Between December 1989 and March 2011, we performed 43 orthotopic liver retransplantations (re-OLTs) among patients aged 20–62 years including 24 women and 19 men. The cold ischemia time was 250–820 minutes. UNOS status before re-OLT: UNOS 1 (n = 19; 44%) UNOS 2A (n = 15; 35%), and UNOS 2B (n = 4; 9%). The time from OLT to re-OLT was 1–2, 146 days. The indications for re-OLT were arterial thrombosis (n = 14; 33%), anastomotic biliary complication (n = 3; 7%), recurrence of the original disease (n = 9; 21%), hepatic vein thrombosis (n = 1; 2%), primary nonfunction (PNF) dysfunction (n = 2; [5%] /6 [14%]), de novo hepatitis C cirrhosis (n = 2; 5%) and other etiologies (n = 6; 14%). Results: The 6-year survival among the primary OLT group was 80% compared with 58% among the re-OLT group (P = .0001). One-year survivals in the re-OLT group according to UNOS status 1, 2A, and 2B were 47%, 60%, and 75%, respectively (P = .475). There was a low negative correlation between survival time and time between OLT and re-OLT. There was a low positive correlation between survival time and cold ischemia time. There was a low negative correlation between survival time and patient age. Conclusions: There was a significant difference in survival between OLT and re-OLT. There was a correlation between survival time and time to re-OLTx; a shorter time corresponded to longer survival. There was a poor correlation between survival time and patient age. UNOS status before re-OLT and indication for re-OLTx influenced survival. [Copyright &y& Elsevier]

Abstract: Background and Aim: End-stage liver failure is associated with severe abnormalities in menstrual and reproductive function. These abnormalities may be reversed by successful orthotopic liver transplantation (OLT). The aim of the study was to investigate menstrual patterns and sex hormone profiles among female liver transplant recipients of reproductive age. Methods: The study group consisted of 24 women of reproductive age with end-stage liver failure who underwent successful OLT. Menstrual patterns and sex hormone profiles were analyzed before as well as 3 and 12 months after OLT. Twenty-seven healthy women of reproductive age served as controls. Biochemical parameters of liver function were assessed before and after OLT. Results: Amenorrhea was the most commonly observed abnormality of menstrual cycle in women with end-stage liver failure (71% of patients). The recurrence of regular menstrual cycles was observed in 35% of patients 3 months after OLT. The percentage increased to 70% at 1 year after grafting and was clearly associated with stabilization of liver function. Similar levels of follicle stimulation hormone (FSH), luteinizing hormone (LH), prolactine (PRL), and testosterone (T) as well as lower levels of estradiol (E2), dehydroepiandrostendione sulphate (DHEA-S), and progesterone, (P) were observed in patients with liver failure compared with healthy women. We observed normalization of E2 and DHEA-S levels after OLT. Conclusions: Amenorrhea, the most common menstrual disturbance in women with end-stage liver failure, may be reversed by OLT. One year after OLT menstrual bleedings were noted in 74% of patients of reproductive age. The recurrence of reproductive function indicated the need for effective and safe family planning methods in that group of patients. [Copyright &y& Elsevier]

Abstract: Introduction: Early septic complications may be a deciding factor for successful recovery among patients who have undergone orthotopic liver transplantation. Therefore, monitoring liver function parameters plays an important role in postoperative treatment to achieve an early diagnosis of postsurgical complications. We ought to measure standard liver function parameters and the expression levels for selected cytokines among patients exhibiting symptoms of infection after orthotopic liver transplantation. Materials and methods: The study was performed on 30 patients who were divided into two groups: SI-0 consisted of patients free of infection, and SI-1, those who had symptoms of infection. We determined standard liver function parameters and expression of hepatocyte growth factor (HGF), interleukin (IL)-6, transforming growth factor (TGF)-β1, and TGF-β2. Results: There were no significant differences in standard liver function parameters between the two groups of patients. There were no significant differences in the levels of expression for the cytokines in question between the two groups of patients. Conclusions: Although standard liver function parameters provide diagnostically valuable information on the patient''s condition, they cannot be used to determine the extent of systemic infection among patients showing signs of infection after liver transplantation. Determining gene expression levels in circulating lymphocytes is a sensitive method to monitor patients'' condition after liver transplantation. The expression levels of HGF, IL-6, TGF-β1, and TGF-β2 in circulating lymphocytes were not sufficiently specific to diagnose transitory postsurgical complications such as symptomatic infection. [Copyright &y& Elsevier]

Abstract: Hepatocyte growth factor (HGF) plays a key role in the regulation of liver regeneration after hepatocyte damage. Changes in HGF gene expression reflect the status of the regeneration process. Aim: The aim of this study was to ascertain the clinical significance of the expression of HGF among liver transplant patients. Methods: Expression of the mRNA of HGF among peripheral blood lymphocytes were measured prior to as well as at 1, 2, 6, and 10 days after liver transplantation in a group of 30 liver recipients. Results: In first 24 hours after reperfusion, the patients with compromised graft function (group 1) showed persistently higher HGF gene expression after reperfusion compared with patients displaying well-functioning grafts (group 0; P = .0189). Between postoperative days 1 and 10, there was a rapid decrease in gene expression among group 0 compared with group 1 (P = .0155). The significant decrease observed in the both groups reached a certain plateau after 48 hours postoperatively. There was no statistical difference in aminotransaminase levels over the days after liver transplantation. The decreased mRNA HGF expression in lymphocytes preceded the decrease in aminotransferase levels. Conclusions: HGF was more sensitive to predict early graft function than prothrombin time, aspartate aminotransferase, and alanine aminotransferase levels. The determination of HGF expression level in lymphocytes after liver transplantation may yield valuable information for evaluation of early graft function. [Copyright &y& Elsevier]

Abstract: Aim: A high rate of cesarean sections has been reported among high-risk pregnancies in liver transplant recipients. The aim of this study was to analyze the course of deliveries and the indications for cesarean sections in women after liver transplantation. Materials and Methods: From 2001 to 2006, we noted 21 deliveries in 17 liver recipients. The mean age of women was 27.9 ± 6.6 years and the mean time from transplantation to pregnancy was 4.3 ± 3.6 years. Most patients were primigravidas on tacrolimus-based immunosuppressive regimens. We retrospectively analyzed obstetric data regarding the delivery and the early puerperium. Results: We noted 6 vaginal deliveries (29%) and 15 cesarean sections (71%). Mean gestational age in the group of vaginal deliveries was 37.6 ± 2.2 weeks. No labor complications were noted. All neonates were delivered in a good state (Apgar score from 8 to 10 points) with mean birth weight of 2725 g. All cesarean sections were performed for obstetric indications: fetal distress, breech presentation, intrauterine growth retardation, or complications related to premature labor. Mean gestational age was 37.0 ± 1.9 weeks. The Apgar scores ranged from 4 to 10 points; mean birth weight was 2787 g. The mean period of hospitalization after surgical labor was 4 days longer compared with the vaginal delivery group. Conclusion: The high rate of cesarean sections (71%) in liver recipients is associated with a great incidence of obstetric complications of pregnancy. Safe and uneventful vaginal delivery is possible with growing experience in the management of pregnant transplanted women. [Copyright &y& Elsevier]

Abstract: Excellent long-term outcomes of transplant patients let many female liver-recipients experience perimenopausal problems. This study assessed menstrual patterns and sex hormone profiles in women of perimenopausal age who experienced end-stage liver failure treated by transplantation (OLT). Materials and methods: Menstrual patterns, sex hormone profiles, and biochemical parameters of liver function were analyzed before and after OLT in 13 liver-transplanted patients of perimenopausal age. Nineteen healthy perimenopausal women served as controls. Results: The most common abnormality of the menstrual cycle observed in the study group was secondary amenorrhea, which affected six liver-transplanted women. Three months after OLT amenorrhea was still observed in six patients, regular menstrual cycles in six and irregular bleeding in one graft recipient. One year after transplantation regular menstruations were noted in four, irregular bleeding in four, and secondary amenorrhea in five liver-transplanted women. Similar levels of follicle stimulating hormone, luetinizing hormone, prolactin, progesterone and testosterone as well as lower levels of estradiol and DHEA-sulfate were observed in patients with liver failure, both before and after grafting, compared with healthy women. After OLT E2 levels increased from 32.05 ± 18.04 to 49.12 ± 22.21. Conclusions: One year after OLT disturbances in menstrual patterns affect most (69%) perimenopausal female liver recipients. Both before and after OLT significantly lower levels of estradiol and DHEA-S were observed in transplanted patients compared with healthy controls. Hormonal therapy of amenorrhea or irregular menstruations may be required in that group of patients. [Copyright &y& Elsevier]

Abstract: Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease that progresses to end-stage liver disease. There are several specific problems related to the posttransplantation period in these patients. The aim of this study was to analyze a single center experience with 17 orthotopic liver transplantations (OLT) due to PSC. Patients and Methods: Seventeen patients were included (10 men, 7 women). Actuarial patient and graft survival rates and the incidence of recurrent sclerosing cholangitis were determined at 1, 5, and 7 years. Results: Fifteen patients received single grafts, whereas two patients required retransplants. Patients received either cyclosporine (n = 7) or tacrolimus (n = 10) based immunosuppression. The 1-, 5-, and 7-year patient survival rates were 80%, 60%, and 60%, respectively, whereas the graft survival rates were 88%, 65%, and 65%, respectively. Two patients had cholangiocarcinomas (CCA) diagnosed during OLT; both recurred within 6 months and had a fatal outcome. Two patients (12%) developed recurrent sclerosing cholangitis, as assessed by liver histology and imaging of biliary tree. Conclusions: Liver transplantation provides good patient and graft survival rates in cases affected with PSC. CCA is associated with poor recipient survival. Recurrent PSC occurs in approximately 12% of cases but does not significantly affect patient survival. [Copyright &y& Elsevier]

Abstract: Aim: According to statistics, women constitute one-third of all liver recipients and approximately 75% of female recipients are of reproductive age. Successful liver transplantation in these patients results in the restoration of menstrual function and fertility. The aim of this study was to assess the course of pregnancy and delivery in liver-transplanted women. Materials and Methods: We retrospectively analyzed data of 138 liver-transplanted women, aged from 18 to 63 years, who underwent regular gynecological evaluations. Among 77 patients of reproductive age, 11 women conceived and delivered babies. Results: All patients have successfully delivered. The mean gestation age at delivery was 36.5 weeks. All neonates were delivered in a good state with no congenital abnormalities. Common pregnancy complications were preterm birth, anemia, intrahepatic cholestasis, and infection. In 1 case, graft rejection was observed due to willful discontinuation of immunosuppressive therapy. Two spontaneous vaginal deliveries and 9 caesarean sections were performed. All caesarean sections were performed for obstetrical indications: fetal intrauterine asphyxia (n = 4), breech presentation (n = 2), threatening intrauterine infection (n = 2), and preterm twin delivery (n = 1). Conclusion: High-risk pregnancies in liver-transplanted women are generally associated with good outcomes, although an increased rate of preterm labor, intrauterine infections, anemia, and cholestasis were observed. Pregnancy did not seem to impair graft function or accelerate rejection in patients receiving immunosuppressive therapy. [Copyright &y& Elsevier]