Hepatalna adenomatoza - prikaz rijetke indikacije za transplantaciju jetre

The most successful treatment option for end-stage liver failure is liver transplantation. Cirrhosis, acute liver failure, and liver cancer are the most common reasons for liver transplantation. Croatia is a member of the Eurotransplant program and performs more than 100 liver transplants annually.Transplantacija jetre je trenutno najuspješniji modalitet liječenja jetrenih bolesti u završnom stadiju. Najčešće indikacije za transplantaciju jetre su ireverzibilno zatajenje jetre uzrokovano cirozom, akutno fulminantno zatajenje te karcinom jetre. Republika Hrvatska je uspješna članica Eurotransplant programa, a godišnje se provede više od 100 transplantacija jetre

Older Age in Croatian Clinical Practice is not Discriminative Factor for Liver Transplantation

Transplantacija jetre je oblik terapije kod ireverzibilnog akutnog ili kroničnog zatajenja jetre. Bolje liječenje brojnih bolesti rezultiralo je produženjem životnog vijeka s posljedičnim starenjem populacije. Valja naglasiti da ne postoji dobna granica kako za primatelja tako ni za davatelja organa kod transplantacijskog liječenja, pa se sve češće radi o starijim primateljima/davateljima organa. Cilj ovog rada je utvrditi udio bolesnika starijih od 65 godina liječenih transplantacijom jetre u ukupnom broju jednako liječenih bolesnika, te prikazati vrstu i učestalost komplikacija ovakvog liječenja. Od 1. siječnja 2013 do 1. rujna 2019. godine u KB Merkur transplantacijom jetre liječeno je ukupno 746 bolesnika od kojih je 206 (27,6 %) bilo starije od 65 godina. U toj podskupini bolesnika najčešća indikacija za transplantaciju jetre bila je primarna neoplazma jetre (44,2 %), potom alkoholna bolest jetre (29,6 %), dok su ostale indikacije bile prisutne u 26,2 % bolesnika. Mortalitet tijekom zahvata ili u posttransplantacijskom praćenju u ovoj podskupini bolesnika iznosio je 31 %. Najčešći uzroci smrti bile su: infekcije, sepsa i multiorgansko zatajenje. Kao zaključak može se reći da životna dob bolesnika nije kontraindikacija za transplantacijsko liječenje, osobito kod bolesnika kojima je to jedina metoda liječenja bolesti u vitalnoj indikaciji. Psihijatrijska procjena je važan i sastavni dio pre- i posttransplantacijske faze praćenja bolesnika.Background: Liver transplantation is a method of treatment for irreversible end-stage liver insufficiency. Improved treatment of various diseases has led to the extension of life expectancy and consequently older world population. It must be pointed out that there is no age limit either for organ donation or organ transplantation. Since the population is getting older, today more and more patients who receive liver transplantation are elderly patients. The aim of this study was to show the percentage of elderly patients who received liver transplantation in our centre, as well as to analyse the rate and type of complications of the treatment. The study was retrospective, and included patients treated by liver transplantation in the period between January 1, 2013 and September 1, 2019 at the University Hospital Merkur. There were 746 treated patients, 206 of whom (27.6%) were elderly (>65 years) patients. The main indication for the treatment was primary liver neoplasm (44.2%), followed by alcohol liver disease (29.6%), and other indications (26.2%). The mortality rate during operation and in the post-transplantation follow up period was 31%. The most frequent cause of death were infections, sepsis, and multiorgan failure. Conclusion: Older age is not a contraindication for liver transplantation, especially if it is a lifesaving procedure. Psychiatric assessment is an important and integral part of the pre- and post-transplantation follow-up phase

Nonalcoholic fatty liver disease and liver transplantation - Where do we stand?

Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) is a challenging and multisystem disease that has a high socioeconomic impact. NAFLD/ NASH is a main cause of macrovesicular steatosis and has multiple impacts on liver transplantation (LT), on patients on the waiting list for transplant, on posttransplant setting as well as on organ donors. Current data indicate new trends in the area of chronic liver disease. Due to the increased incidence of metabolic syndrome (MetS) and its components, NASH cirrhosis and hepatocellular carcinoma caused by NASH will soon become a major indication for LT. Furthermore, due to an increasing incidence of MetS and, consequently, NAFLD, there will be more steatotic donor livers and less high quality organs available for LT, in addition to a lack of available liver allografts. Patients who have NASH and are candidates for LT have multiple comorbidities and are unique LT candidates. Finally, we discuss long-term grafts and patient survival after LT, the recurrence of NASH and NASH appearing de novo after transplantation. In addition, we suggest topics and areas that require more research for improving the health care of this increasing patient population

Liver transplantation in patients with neuroendocrine tumors: a case series and literature review

Neuroendocrine tumors (NET) are a rare and heterogeneous group of neoplasms with variable biological behavior. They frequently metastasize to the liver, requiring active, multimodality treatment. Surgical resection, possible in only a minority of cases, was until recently the only potentially curative option. For unresectable NET with liver metastases, liver transplantation (LT) emerged as a potential curative treatment due to relatively slow growth and indolent behavior of the metastases. In this case series with literature review, we retrospectively analyzed the characteristics of 12 highly selected patients with metastatic NET disease as an indication for LT treated in our center. We also summarized the proposed prognostic factors, and evaluated and compared the existing selection criteria. The main poor prognostic factors in our patients were high grade NET and primary tumor in the pancreas. Inconsistent liver transplantation outcome parameters make it difficult to standardize patient selection criteria. There is a need for further studies that would fully elucidate the curative potential of LT in patients diagnosed with NET

Liver Disease During Pregnancy: A Challenging Clinical Issue

One of the least studied topics in the field of obstetrics is liver disease during pregnancy, which creates a challenge for both gynecologists and hepatologists. Approximately 3% of pregnant women are affected by some form of liver disease during pregnancy. Some of these conditions can be fatal for both the mother and child. In addition, 3 types of liver disease need to be differentiated during pregnancy. One type is liver disease directly related to pregnancy, which can occur at a specific time during pregnancy. Another type is liver disease not related to pregnancy, which can occur at any time, such as viral- or drug-induced hepatitis. Furthermore, pregnancy can occur in women with pre-existing liver disease. It is essential that the clinicians are familiar with this disorder so they can respond promptly and appropriately in all of these situations, especially when emergency delivery is needed and must not be postponed

Croatian guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a term describing excessive accumulation of fat in hepatocytes, and is associated with metabolic syndrome and insulin resistance. NAFLD prevalence is on increase and goes in parallel with the increasing prevalence of metabolic syndrome and its components. That is why Croatian guidelines have been developed, which cover the screening protocol for patients with NAFLD risk factors, and the recommended diagnostic work-up and treatment of NAFLD patients. NAFLD screening should be done in patients with type 2 diabetes mellitus, or persons with two or more risk factors as part of metabolic screening, and is carried out by noninvasive laboratory and imaging methods used to detect fibrosis. Patient work-up should exclude the existence of other causes of liver injury and determine the stage of fibrosis as the most important factor in disease prognosis. Patients with initial stages of fibrosis continue to be monitored at the primary healthcare level with the management of metabolic risk factors, dietary measures, and increased physical activity. Patients with advanced fibrosis should be referred to a gastroenterologist/ hepatologist for further treatment, monitoring, and detection and management of complications

Extended Prophylactic Effect of N-tert-Butyl-α-phenylnitron against Oxidative/Nitrosative Damage Caused by the DNA-Hypomethylating Drug 5-Azacytidine in the Rat Placenta

Antioxidant N-tert-Butyl-α-phenylnitron (PBN) partly protected embryos from the negative effects of a DNA demethylating drug 5-azacytidine during pregnancy. Our aim was to investigate PBN’s impact on the placenta. Fischer rat dams were treated on gestation days (GD) 12 and 13 by PBN (40 mg/kg), followed by 5azaC (5 mg/kg) after one hour. Global methylation was assessed by pyrosequencing. Numerical density was calculated from immunohistochemical expression in single cells for proliferating (PCNA), oxidative (oxoguanosine) and nitrosative (nitrotyrosine) activity. Results were compared with the PBN-treated and control rats. PBN-pretreatment significantly increased placental weight at GD15 and GD20, diminished by 5azaC, and diminished apoptosis in GD 20 placentas caused by 5azaC. Oxoguanosine expression in placentas of 5azaC-treated dams was especially high in the placental labyrinth on GD 15, while PBN-pretreatment lowered its expression on GD 15 and GD 20 in both the labyrinth and basal layer. 5azaC enhanced nitrotyrosine level in the labyrinth of both gestational stages, while PBN-pretreatment lowered it. We conclude that PBN exerted its prophylactic activity against DNA hypomethylating agent 5azaC in the placenta through free radical scavenging, especially in the labyrinthine part of the placenta until the last day of pregnancy