Localization of apoptosis proteins and lymphocyte subsets in chronic rejection of human liver allograft

L

Extended criteria donors in liver transplantation Part I: reviewing the impact of determining factors

K

Extended-criteria donors in liver transplantation Part II: reviewing the impact of extended-criteria donors on the complications and outcomes of liver transplantation

K

Recurrence of primary sclerosing cholangitis after liver transplantation: the Hungarian experience

L

Bakteriális infekciók májátültetés után

INTRODUCTION: The authors reviewed the prevalence of postoperative infections, the results of bacterium cultures, and the incidence of multidrug resistance in their liver transplanted patients during a period between 2003 and 2012. AIM: The aim of this study was to analyse risk factors and colonisations of bacterial infections. METHOD: The files of 408 patients (281 bacterium cultures) were reviewed. RESULTS: Of the 408 patients 70 had a postoperative infection (17%); 58 patients (14.2%) had positive and 12 patients (2.9%) negative bacterial culture results. Cholangitis was found in 7 cases (12.1%), abdominal infection in 17 cases (29.3%), and pulmonal infection in 28 cases (48.3%). Postoperative infection was more frequent in patients with initial poor graft function, acute renal insufficiency, biliary complication, and in those with intraabdominal bleeding. The 1-, 3- and 5-year cumulative survival of patients who had infection was 70%, 56% and 56%, respectively, whereas the cumulative survival data of patients without infection was 94%, 87% and 85%, respectively (p<0.001). Multidrug resistance was found in 56% of the positive cultures, however, the one-year survival was not different in patients who had multidrug resistance positive and negative bacterial infection (both 70.2%). CONCLUSIONS: Infection control must target the management of multidrug resistance microbes through encouraging prevention, hygienic, and isolation rules, improving the operational, transfusion, and antimicrobial policy in a teamwork setting. Orv. Hetil., 2015, 156(34), 1366-1382

Veseérintettség májátültetés során

Introduction: In liver cirrhosis renal function decreases as well. Hepatorenal syndrome is the most frequent cause of the decrease, but primary kidney failure, diabetes mellitus and some diseases underlying endstage liver failure (such as hepatitis C virus infection) can also play an important role. In liver transplantation several further factors (total cross-clamping of vena cava inferior, polytransfusion, immunosuppression) impair the renal function, too. Aim: The aim of this study was to analyse the changes in kidney function during the first postoperative year after liver transplantation. Method: Retrospective data analysis was performed after primary liver transplantations (n = 319). Results: impaired preoperative renal function increased the devepolment of postoperative complications and the first year cumulative patient survival was significantly worse (91,7% vs 69,9%; p<0,001) in this group. If renal function of the patients increased above 60 ml/min/1,73 m2 after the first year, patient survival was better. Independently of the preoperative kidney function, 76% of the patients had impaired kidney function at the first postoperative year. In this group, de novo diabetes mellitus was more frequently diagnosed (22,5% vs 9,5%; p = 0,023). Conclusions: Selection of personalized immunosuppressive medication has a positive effect on renal function. Orv. Hetil., 2013, 154, 1018-1025

Recurrence of primary sclerosing cholangitis after liver transplantation: the Hungarian experience

L

Hepatitis C-vírus-fertőzés kiújulása májátültetés után. Mi változott az elmúlt 10 évben?

Introduction: Management of hepatitis C virus recurrence is a challenge after liver transplantation. Aim: The aim of the authors was to analyse the outcome of liver transplantation performed in hepatitis C virus positive patients during the past ten years and to compare recent data with a previous report of the authors. Method: The authors retrospectively evaluated the data (donors, recipients, perioperative characteristics, patient and graft survival, serum titer of hepatitis C virus RNA, histology) of 409 patients who underwent liver transplantation between 2003 and 2012. Results: 156 patients were transplanted due to hepatitis C virus associated liver cirrhosis (38%). Worse outcome was observed in these patients in comparison to hepatitis C virus negative recipients. The cumulative patient survival rates at 1, 5, and 10 year were 80%, 61%, 51% in the hepatitis C virus positive group and 92%, 85%, 79% in the hepatitis C virus negative group, respectively (p<0.001). The cumulative graft survival rates at 1, 5 and 10 year were 79%, 59% and 50% in hepatitis C virus positive and 89%, 80% and 70% in hepatitis C virus negative patients (p<0.001). Hepatitis C virus recurrence was observed in the majority of the patients (132 patients, 85%), mainly within the first year (83%). The authors observed recurrence within 6 months in 71 patients (56%), and within 3 months in 26 patients (20%). The mean hepatitis C virus recurrence free survival was 243 days. Higher rate of de novo diabetes was detected in case of early recurrence. The cumulative patient survival rates at 1, 3, 5, 10 years were 98%, 89.5%, 81% and 65% when hepatitis C virus recurrence exceeded 3 months and 64%, 53%, 30.5% and 30.5% in patients with early recurrence (p<0.001). Conclusions: Poor outcome of liver transplantation in hepatitis C virus positive patients is still a challenge. Hepatitis C virus recurrence is observed earlier after liver transplantation in comparison with a previous report of the authors. De novo diabetes occurs more frequently in case of early recurrence. Despite an immediate start of antiviral treatment, early recurrence has a significant negative impact on the outcome of transplantation. Orv. Hetil., 2013, 154, 1058-1066

De novo diabetes és májátültetés, különös tekintettel a hepatitis C-vírus kiújulására = New-onset diabetes mellitus after liver transplantation

A de novo diabetes mellitus a májátültetés gyakori szövődménye. Célkitűzés: A de novo diabetes gyakoriságát, jelentőségét és a kockázati tényezők szerepét vizsgáltuk. Módszer: 1995 és 2009 között 310 májátültetett beteg adatait dolgoztuk fel retrospektív módszerrel. De novo diabetest állapítottunk meg, ha az éhomi vércukor a 3. posztoperatív hónapon túl ismételten >6,8 mmol/l volt, és/vagy a májátültetés után tartós, a 3. posztoperatív hónapot meghaladóan is fenntartott antidiabetikus terápia indult. Eredmények: De novo diabetes a betegek 20%-ánál (63 beteg) alakult ki. A de novo és a kontrollcsoport között az alábbiakban találtunk különbséget. Donor-testtömegindex (24±3 vs. 22,4±3,6 kg/m 2 , p = 0,003), férfi nem (58% vs. 33%, p = 0,002). Recipienséletkor (47,6±7,2 vs. 38,3±14,6 év, p<0,001), -testtömegindex (26,7±3,8 vs. 23,3±5,6 kg/m 2 , p<0,001), férfi nem (60% vs. 44%, p = 0,031). A de novo diabetesesek csoportjában a betegek 66%-át HCV talaján kialakult cirrhosis miatt transzplantálták, a kontrollcsoportban ez csak 23% volt (p<0,001). Az 1, 3, 5 és 8 éves kumulatív betegtúlélés a kontrollcsoportban 95%, 91%, 88% és 88%, a de novo csoportban a megfelelő értékek 87%, 79%, 79% és 64% (p = 0,011). Az 1, 3, 5 és 8 éves kumulatív grafttúlélés a kontrollcsoportban 92%, 87%, 86% és 79%, a de novo csoportban a megfelelő értékek 87%, 79%, 79%, 65% (p = NS). Azoknál a betegeknél, akiknél a C-vírus korai (6 hónapon belüli) kiújulását észleltük, többségben de novo diabetes is kialakult (74% vs. kontroll 26%, p = 0,03). A betegek 53%-ában észleltünk tízszeres vírustiter-emelkedést a műtét utáni 6 hónapon belül a preoperatív értékhez viszonyítva diabetes kialakulása esetén, a kontrollnál ez 20% volt (p = 0,028). A de novo csoportban magasabb volt az átlagos (Ishak-Knodell) fibrosis score az antivirális kezelés megkezdését követően 1 évvel (2,05±1,53 vs. 1,00±1,08, p = 0,039). Következtetés: Májátültetést követő de novo diabetes kockázati tényezői az időskor, elhízás, férfi nem és a C-vírus okozta cirrhosis. Víruspozitív betegek körében a korai rekurrencia, súlyosabb viraemia és az antivirális kezelés ellenére kialakuló súlyosabb fibrosis összefügg a de novo diabetes kialakulásával. | New-onset diabetes is a common complication after liver transplantation. Aim: We aimed to analyze the incidence and rate of known risk factors and the impact of new-onset diabetes mellitus on postoperative outcome. Methods: We retrospectively evaluated the files of 310 patients who underwent liver transplantation between 1995 and 2009. Definition of new-onset diabetes included: repeated fasting serum glucose >6.8 mmol/l and/or sustained antidiabetic therapy that was present 3 months after transplantation. Results: New-onset diabetes occurred in 63 patients (20%). Differences between the new-onset and the control group were the donor body mass index (24±3 vs. 22.4±3.6 kg/m 2 , p = 0.003), donor male gender (58% vs. 33%, p = 0.002), and recipient age (47.6±7.2 vs. 38.3±14.6 year, p<0.001), body mass index (26.7±3.8 vs. 23.3±5.6 kg/m 2 , p<0.001), male gender (60% vs. 44%, p = 0.031). The 66% of patients with new-onset diabetes were transplanted with cirrhosis caused by hepatitis C virus infection, while in the control group the rate was 23% (p<0.001). Cumulative patient survival rates at 1, 3, 5 and 8 year were 95%, 90.6%, 88% and 88% in the control group, and 87%, 79%, 79% and 64% in the de novo group, respectively (p = 0.011). Cumulative graft survival rates at 1, 3, 5 and 8 year in the control group were 92%, 87%, 86% and 79%, in the de novo diabetes group the rates were 87%, 79%, 79%, 65%, respectively (p = NS). In case of early recurrence (in 6 months), majority of patients developed new-onset diabetes (74% vs. control 26%, p = 0.03). More patients had more than 10 times higher increase of the postoperative virus titer correlate to the preoperative titer in the de novo diabetes group (53% vs. 20%, p = 0.028). Mean fibrosis score was higher in new-onset group one year after the beginning of antiviral therapy (2.05±1.53 vs. 1.00±1.08, p = 0.039). Conclusions: Risk factors for new-onset diabetes after transplantation are elder age, obesity, male gender and cirrhosis due to hepatitis C infection. The early recurrence, viremia and more severe fibrosis after antiviral therapy have an impact on the occurrence of new-onset diabetes in hepatitis C positive patients