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Absztrakt: A szerzők egy 67 éves férfi beteg esetét ismertetik, akinél előzőleg a máj II. szegmentumában képalkotó vizsgálatokkal igazolt térfoglalás miatt II, III szegment teljes és a IV. szegment részleges eltávolítását végezték. Műtét utáni icterus jelent meg, emelkedő tendenciát mutató szérum bilirubin koncentrációval. Képalkotó vizsgálatok elvégzése után reoperatiora került sor. A műtét alatt derült fény a ritka epeúti variánsra. A primér műtétnél a rezekció során lekötésre került a jobb oldali ductus hepaticus, ami intraparenchimálisan ömlött a bal oldali ductus hepaticusba. Az érintetlenül hagyott hílusban nem tűnt fel a jobb extrahepaticus epeút hiánya. Az epeelvezetés Roux-Y-kaccsal végzett hepatico jejunostomiával került megoldásra.

Absztrakt Bevezetés: Transzplantációt követően kialakuló leggyakoribb tumorok a non-melanoma bőrtumorok (Non-Melanoma Skin Cancer, NMSC). Klinikai kollaboráció keretein belül – Magyarországon elsőként – bevezettük a transzplantált betegek rendszeres bőrgyógyászati szűrővizsgálatát, valamint vizsgáltuk kialakulásuk gyakoriságát és kiváltó tényezőit. Betegek és módszerek: A pécsi Sebészeti Klinika gondozásában álló vese- és hasnyálmirigy-vese transzplantáción átesett betegek közül 2008 szeptemberétől 116 beteget (70 férfi, 46 nő) vontunk be. Ez a beteg teljes testfelületének bőrgyógyászati vizsgálatából és a rizikófaktorokat felmérő kérdőív kitöltéséből állt. Eredmények: A szűrővizsgálat során 11 betegnél 16 NMSC-t találtunk (13,8%, átlagéletkor: 49,3 év, férfi : nő = 1 : 1), melyek kialakulásának átlagideje a transzplantációt követően 4,1 év volt. A szövettani vizsgálat 13 basocellularis carcinomát (BCC) és 3 squamocellularis carcinomát (SCC) igazolt. A tumorok BCC : SCC aránya 4 : 1 volt. A NMSC-ok előfordulása szignifikánsan magasabb volt azoknál a betegeknél, akik cyclosporint szedtek, valamint akiknek életük során 2-nél több napégésük volt, vagy tartósan kültéri munkát végeztek (p < 0,05). Következtetések: Eddigi adataink igazolják a transzplantált betegek rendszeres bőrgyógyászati szűrésének jelentőségét, valamint a szorosabb együttműködés fontosságát a transzplantációs sebészek és bőrgyógyászok között. Eredményeink a nemzetközi adatoknak megfelelnek, kivéve a BCC : SCC arányt. Ennek a különbségnek a tisztázásához további vizsgálatokat tervezünk.

Tissue injury caused by cold preservation and reperfusion during small bowel transplantation remains an unsolved problem. Increasing evidence suggests that pituitary adenylate cyclase-activating polypeptide (PACAP) has protective effects in several ischemia-reperfusion (I/R) models. This study investigated the effect of PACAP-38 on oxidative stress in autotransplanted intestine. We established sham-operated, I/R, and autotransplanted groups in Wistar rats (n = 55). We applied ischemia for 1 (GI), 2 (GII), or 3 hours (GIII). In autotransplanted groups, we performed total orthotopic intestinal autotransplantation. Grafts were preserved in University of Wisconsin (UW) solution for 1 (GIV), 2 (GV), 3 (GVI), or 6 (GVII) hours and in PACAP-38-containing UW for 1 (GVIII), 2 (GIX), 3 (GX), or 6 (GXI) hours. Reperfusion lasted 3 hours in each group. Endogenous PACAP-38 values were measured by radioimmunoassay. Oxidative stress parameters malondialdehyde (MDA), reduced glutathione (GSH), and superoxide dismutase (SOD) were measured in tissue homogenates. Concentration of endogenous PACAP-38 significantly decreased in GI to GIII compared with the sham-operated animals following I/R periods (P < .05). Cold preservation in UW and reperfusion of the intestine increased the level of tissue MDA in GIV to GVII, which correlated with the duration of cold storage. The content of GSH decreased in GIV to GVII to levels that were significantly different between GIV and GVIII and between GVII and GXI. SOD activity decreased dramatically in GIV to GVII with significantly higher activity in GIX to GXI. Our findings confirmed that I/R decreased endogenous PACAP-38 concentration. Administration of PACAP-38 to UW solution mitigated the oxidative injury during intestinal autotransplantation.

The prediction of graft rejection can play an important part in graft survival. Analysis of immune reactions has shown that graft rejection shares mechanisms with recurrent abortions during pregnancy. Progesterone-induced blocking factor (PIBF), a mediator of progesterone that blocks natural killer cell activity in peripheral blood, produces antiabortive effects. The aim of this study was to examine the PIBF concentration in the urine of transplanted recipients. The study included 116 white adults (70 men and 46 women) of median age 49.3 years, who had undergone kidney transplantations. The median duration after transplantation was 3.46 years. The average period between renal disease and our measurement was 12.3 years, and the median interval between graft rejection and our study was 1.75 years. Urine samples were used to measure PIBF concentrations by an enzyme-linked immunsorbent assay. PIBF urinary concentrations decreased significantly in patients who experienced ≥1 rejection episode (31.8 ± 2.2 ng/mL) compared with those without any episode (22.7 ± 1.2 ng/ml; P < .01). Moreover, the urinary PIBF level was significantly lower among patients who had increased creatinine and urea nitrogen levels in blood samples (P < .05 and P < .01, respectively). Decreased PIBF values in kidney transplant patients followed previous rejection episodes. A close negative correlation was observed between urinary PIBF concentrations and blood levels of creatinine and urea nitrogen. These findings suggested that PIBF detection may predict graft rejection in transplant recipients.

There is increasing evidence that nonmelanoma skin cancers (NMSCs) are the most frequently observed tumors in transplant recipients. The incidence of posttransplantation NMSC was determined using our dermatologic screening program. Included in the study were 116 white adults (70 men and 46 women; median age, 49.3 years) who had undergone kidney or combined kidney-pancreas transplantation, with follow-up from September 2008 to December 2009. All patients underwent a full skin examination for NMSC, and completed a standardized questionnaire. Screening resulted in detection of 16 NMSCs in 11 patients out of 116 (9.5%). Lesions were equally distributed by sex, and were detected at a median of 4.1 years posttransplantation. Histologic analysis verified 13 basal cell carcinomas and 3 squamous cell carcinomas (ratio, 4:1). The incidence of NMSC was significantly greater in patients who received cyclosporine immunosuppression therapy (16 vs 1; P < .05), had experienced 2 or more painful sunburns before transplantation (10 vs 11), or worked outdoors (10 vs 11). These data indicate the relevance of skin cancer surveillance in transplant recipients. Our results correspond to international statistics except for the ratio of basal cell carcinoma to squamous cell carcinoma. Further studies are needed to elucidate the reasons for this difference.

Transplant recipients are at high risk of nonmelanoma skin cancer (NMSC). Ultraviolet radiation can generate oxygen free radicals (OFRs), leading to oxidative stress and carcino-genesis, primarily during immunosuppression therapy. In the present study, changes in oxidative stress were examined in transplant recipients with and without NMSC. The study included 116 white adults who had undergone kidney or combined kidney-pancreas transplantation. Dermatologic follow-up revealed 16 NMSCs (13.8%). To monitor oxidative stress, peripheral blood samples were used to measure malondialdehyde (MDA), reduced glutathione, sulfhydryl (-SH) groups, OFRs, and activity of myeloperoxidase, superoxide dismutase, and catalase. The mean (SD) plasma MDA concentration was significantly greater in patients without NMSC compared with healthy control individuals (0.48 ± 0.05 nmol/mL; P < .05), whereas MDA concentration in hemolysate was slightly increased. In peripheral blood samples, the MDA concentration in both plasma (0.71 ± 0.03 nmol/mL) and hemolysate (87.74 ± 1.25 nmol/mL) was significantly increased in the NMSC group compared with the healthy control group (0.24 ± 0.05 nmol/mL vs 75.87 ± 2.8 nmol/mL; P < .05) or patients without NMSC (0.48 ± 0.04 nmol/mL vs 79.62 ± 2.77 nmol/mL; P < .05). The reduced glutathione concentration was significantly decreased in the -SH groups compared with the healthy control group (P < .05). Antioxidant activity of myeloperoxidase (0.78 ± 0.05 IU/mL) and catalase (1855.8 ± 45.41 IU/mL) was significantly increased in the group without NMSC compared with the healthy control group (0.41 ± 0.1 IU/mL vs 1642.07 ± 82.96 IU/mL) and the NMSC group (0.93 ± 0.03 IU/mL vs 2180.5 ± 15.03 IU/mL). The superoxide dismutase activity was decreased slightly but not significantly. Total production of OFRs was significantly greater in the NMSC group compared with the non-NMSC group or the healthy control group (P < .05). These findings suggest that an imbalance exists between pro-oxidant and antioxidant status in transplant recipients, with a significant difference in patients with vs without NMSC.

Tissue injury caused by cold preservation and reperfusion remains an unsolved problem during small-bowel transplantation. Pituitary adenylate cyclase-activating polypeptide (PACAP) is present and plays a central role in the intestinal physiology. This study investigated effect of PACAP-38 on the oxidative stress and tissue damage in autotransplanted intestine. Sham-operated, ischemia/reperfusion, and autotransplanted groups were established in Wistar rats. In ischemia/reperfusion groups, 1 h (group A), 2 h (group B), and 3 h (group C) ischemia followed by 3 h of reperfusion was applied. In autotransplanted groups, total orthotopic intestinal autotransplantation was performed. Grafts were preserved in University of Wisconsin (UW) solution and in UW containing 30 microg PACAP-38 for 1, 2, 3, and 6 h. Reperfusion lasted 3 h in all groups. Endogenous PACAP-38 concentration was measured by radioimmunoassay. To determine oxidative stress parameters, malondialdehyde, reduced glutathione, and superoxide dismutase were measured in tissue samples. Tissue damage was analyzed by qualitative and quantitative methods on hematoxylin/eosin-stained sections. Concentration of endogenous PACAP-38 significantly decreased in groups B and C compared to sham-operated group. Preservation solution containing PACAP-38 ameliorated bowel tissue oxidative injury induced by cold ischemia and reperfusion. Histological results showed that preservation caused destruction of the mucous, submucous, and muscular layers, which were further deteriorated by the end of reperfusion. In contrast, PACAP-38 significantly protected the intestinal structure. Ischemia/reperfusion decreased the endogenous PACAP-38 concentration in the intestinal tissue. Administration of PACAP-38 mitigated the oxidative injury and histological lesions in small-bowel autotransplantation model.

Liver transplantation (LT) is the sole treatment modality of most of diffuse liver diseases. Simultaneous-pancreas-kidney (SPK) transplantation is also a life saving operation for IDDM patients. Both procedures are established treatment options in the European Community (EC) and in the US. These procedures are performed in a significantly smaller number in Hungary. Having a larger demand for LT than the supply of cadaver donors alternative solutions are sought to increase the number of transplantable livers. In Hungary partly the shortage of donors and the shortage of recipients are the factors rendering the number of LTs and SPKs low. These factors can be changed by better organisation and good survival data that make the two procedures accepted by the community of physicians.

Cavernous haemangiomas of the liver were surgically treated in 36 women and 14 men over a 10-year period. The tumours were solitary in 42 cases and multiple in 8. Locations were the right lobe in 39 cases, the left one in 5 and both lobes in 6. The size of the tumours ranged from 0.4 to 14 cm in diameter. Enucleation of tumours was carried out in 29 cases, an atypical liver resection in 19 cases, anatomical lobectomy in 2 cases and a right trisegmentectomy in 1 case. There was no mortality. Morbidity rate seems to be lower in patients who underwent enucleation. The authors indicate the importance of enucleation for removal of liver haemangiomas of various sizes.