Orthotopic Liver Retransplantation – Case Report

We report a case of orthotopic liver retransplantation (OLRT) in a patient who was suffering from rejection and graft failure after orthotopic liver transplantation (OLT). The patient was a 32-year old female who had diagnosed liver lesion – hepatic cirrhosis. Within two months, with presented condition as a terminal stage of her disease, she underwent the OLT and immunosuppressive postoperative management. Two months after the OLT, in the one-week period, the patient underwent two new operations because of obstructive icterus due to fulminant cholangitis and subhepatic abscess. In spite of this operative and conservative treatment the patient’s condition did not improve. Because of graft failure due to bile duct necrosis, she underwent an ORLT operation and her condition is satisfactory, till now. We confirmed that the overall impact of retransplatation persists because patients undergoing elective retransplatation have significantly better prognosis than those requiring an emergency operation

Abernethy malformation as a rare indication for liver transplantation: Case report

Abernethyjeva malformacija ili kongenitalna ageneza portalne vene (KAPV) rijetka je malformacija abdominalnoga splanhničkog venskog sustava. Dijagnoza se najčešće postavlja u dječjoj dobi i često je povezana s drugim malformacijama poput srčanih grešaka i poremećaja skeletnog sustava, kao i s tumorima jetre. Sama malformacija može se manifestirati u dva oblika. Kod tipa I portalna krv potpuno zaobilazi jetru te se gornja mezenterijska vena i lijenalna vena odvojeno (tip Ia) ili zajedno (tip Ib) dreniraju u donju šuplju venu, a u jetri ne postoje intrahepatalni portalni venski ogranci. Kod tipa II prisutan je parcijalni portokavalni shunt i portalna krv djelomično opskrbljuje jetru. Nema jedinstvenoga terapijskog pristupa za sve bolesnike s Abernethyjevom malformacijom, međutim, kod bolesnika sa simptomima jetrene bolesti (encefalopatija, loša funkcija jetre) te onih s tumorima jetre preporučuje se transplantacija jetre. U ovom radu prikazujemo Abernethyjevu malformaciju tipa Ib u 17-godišnje bolesnice kod koje se obradom kronične malaksalosti praćene bolima pod desnim rebrenim lukom pronašao neresektabilni tumor jetre te joj je uspješno obavljena ortotopna transplantacija jetre.Abernethy malformation or congenital agenesis of the portal vein (CAPV) is a rare malformation of the abdominal splanchnic venous system. This malformation is commonly found in children and is often associated with other malformations such as congenital cardiac anomalies and skeletal system disorders, as well as liver tumors. There are two types of Abernethy malformation. In type I, portal blood bypasses the liver completely, with the superior mesenteric vein and the splenic vein draining into the inferior vena cava separately (type Ia), or together (type Ib). There are no intrahepatic portal vein branches in the liver. Type II is a partial portocaval shunt in which portal blood partially supplies the liver. There is no unified therapeutic approach for all patients with Abernethy malformation, however, liver transplantation is recommended in patients with liver disease (encephalopathy, poor liver function) and those with liver tumors. In this case report we present a case of Abernethy type Ib malformation in a 17-year-old patient with chronic malaise and uper abdominal pain. During diagnostic work-up, an unresectable liver tumor was found and the patient was successfully treated with orthotopic liver transplantation

Assessment of nutritional support in patients after liver and kidney transplantation

During the last decades organ transplantation has evolved into a proven therapy for end-stage organ failure. However, the long-term success of organ transplantation depends significantly on the patients’ ability to overcome possible postoperative complications and to recover from a severe metabolic imbalance. Therefore, in the present study we assessed the accuracy of the early post-operative nutritional intake in a vulnerable group of patients after organ transplantation and compared it with the calculated minimal nutritional requirements. A number of 61 patients were included in the study, 48 with liver, 11 with kidney, and two patients with both, liver and kidney transplants. Mini nutritional assessment (MNA) was applied and total nutritional intake was recorded for fourteen consecutive post-transplant days. Serum concentrations of proteins, urea and creatinine, as well as catalytic concentrations of liver enzymes were measured. Urea to creatinine ratio was calculated. According to body mass index (BMI) only a few patients were malnourished, but low serum protein levels indicated a significant protein catabolism. Nutritional requirements were provided mainly by glucose, with low amounts of proteins, i.e. amino acids, and fats. It took more than seven days to reach the appropriate nutritional intake. Because of the intensive catabolism, especially of proteins, nutrition of organ transplant recipients requires permanent monitoring and better nutritional support through formulas for enteral and total parenteral nutrition

Relationship between recipient and donor factors and kidney transplant outcome

Cilj: Iako je transplantacija bubrega najbolja metoda nadomještanja bubrežne funkcije, još uvijek postoji potreba za poboljšanjem dugoročnih ishoda. Cilj rada bio je utvrditi neovisnu povezanost demografskih čimbenika primatelja i darivatelja, osnovne bubrežne bolesti, trajanja liječenja dijalizom, tkivne nepodudarnosti i senzibilizacije s ishodima transplantacije u suvremenoj kohorti pacijenata kojima je presađen bubreg. Ispitanici i metode: U istraživanje su uključeni pacijenti kojima je transplantiran bubreg u Kliničkoj bolnici Merkur od lipnja 2007. do kraja 2018. god. Ishodi transplantacije praćeni su do 31. 12. 2019. godine. Najkraće vrijeme praćenja bila je jedna godina. Podaci su prikupljeni korištenjem izvješća iz aplikacije Eurotransplant Network Information System (ENIS; www.eurotransplant.org). Preživljenje je prikazano Kaplan-Meierovim krivuljama. Povezanost preživljenja s određenim obilježjima primatelja i darivatelja analizirana je univarijatnom i multivarijatnom Coxovom regresijom. Rezultati: U razdoblju od lipnja 2007. do konca 2018. presađeno je 480 bubrega u 472 pacijenta. 10-godišnje preživljenje pacijenata iznosilo je 72 %. Desetgodišnje preživljenje bubrega cenzurirano za smrt pacijenata s bubregom u funkciji bilo je 93 %. U multivarijatnoj analizi jedino dob primatelja pri transplantaciji, šećerna bolest kao uzrok osnovne bubrežne bolesti i trajanje liječenja dijalizom ostali su neovisno povezani s preživljenjem pacijenata. Zaključak: Transplantacija bubrega rezultira odličnim dugoročnim preživljenjem bubrega. Potrebno je poboljšati dugoročno preživljenje pacijenata, prevencijom, ranim otkrivanjem i intenzivnim liječenjem kroničnih bolesti.Aim: Although kidney transplantation is the best method of replacing renal function, there is still a need to improve long-term outcomes. The aim of this study was to determine the independent association of recipient and donor demographic factors, underlying renal disease, duration of dialysis treatment, tissue typing mismatch, and sensitization with transplant outcomes in a contemporary cohort of kidney transplant patients. Patients and methods: The study included patients who had a kidney transplantation at Clinical Hospital Merkur from June 2007 to the end of 2018. Transplant outcomes were monitored until December 31, 2019. The minimum follow-up time was 1 year. Data were collected using reports from the Eurotransplant Network Information System (ENIS) application (www.eurotransplant.org). Survival is shown by Kaplan-Meier curves. The association of survival with specific recipient and donor characteristics was analyzed by univariate and multivariate Cox regression. Results: In the period from June 2007 to the end of 2018, 480 kidneys were transplanted in 472 patients. The 10-year patient survival was 72%. Ten-year renal survival censored for the death of renal function patients was 93%. In the multivariate analysis, only recipient age at transplantation, diabetes as the cause of underlying renal disease and duration of dialysis remained independently associated with patient survival. Conclusion: Long-term graft survival is excellent after kidney transplantation. Long-term patient survival can be improved by prevention, early detection and intensive treatment of chronic diseases

Dinamika koštanog metabolizma nakon transplantacije jetre

Deterioration of bone metabolism is a major complication of end-stage liver disease. Chronic liver disease and its associated conditions, including hypogonadism, disturbed vitamin D and bile metabolism, malnourishment, alcohol ingestion, and poor physical activity all lead to decrease in bone mineral density (BMD). In addition, loss of bone mass in the early post-transplant period is known to be rapid and has been ascribed to the effects of corticosteroids, immunosuppressive agents and immobilization in the early postoperative period. Bone mass deficit leads to an increased risk of fractures in transplanted patients, with concomittant increased morbidity and mortality in those patients. The primary objective of this study was to monitor bone metabolism, ie. the dynamics of bone resorption and formation, osteoprotegerin, and vitamin D status in the liver transplant patients over the course of the first year following transplantation. The dynamics of bone metabolism was investigated in the study comprised 88 patients and included measurement of biochemical parameters of bone turnover, 25- hydroxy vitamin D and osteoprotegerin (decoy ligand for osteoclast function) at transplantation, afer 14 days, 3, 6 and 12 months. Densitometry was performed at the left hip and lumbar spine in 22 patient after 6 and 12 months. Results of biochemical measurements indicated increased bone resorption during the entire follow-up period, decreased bone formation as assessed by osteocalcin which normalized, 25-OH D deficiency, and initially increased osteoprotegerin which also normalized in this period. Other bone formation markers P1CP and bone alkaline phosphatase were mostly within normal range. Crosslaps decreased after 14 days and thereafter (p=0.005), osteocalcin increased (p<0.02) and osteoprotegerin decreased (p<0.003) after initial measurements; 25-OH D deficiency further decreased after 3 months (p<0.02); P1CP decreased after 3 and 12 months (p<0.02); bone alkaline phosphatase increased after 14 days and 6 months (p<0.03). Bone mass in most patients was either normal or osteopenic, with improvement at the left hip after 12 months (p<0.01), but no change at the lumbar spine. Metabolic bone disorder in the first post-transplant year was characterised by decreased bone formation which improves almost immediately after liver transplantation, and continuosly increased bone resorption. Variations in osteoprotegerin levels corresponded to osteoblast and osteoclast cell activities. Bone mass in liver transplant recipients was normal or osteopenic, but improved only for the hip site

Emergence of <i>Echinococcus multilocularis</i> in Central Continental Croatia: A Human Case Series and Update on Prevalence in Foxes

Human alveolar echinococcosis (HAE), caused by the metacestode stage of Echinococcus multilocularis, has emerged in many European countries over the last two decades. Here, we report the first data on the new HAE focus with increasing incidence in central Croatia, describe its clinical presentation and outcomes in diagnosed patients, and provide an update on the prevalence and geographic distribution of Echinococcus multilocuaris in red foxes. After the initial case in 2017 from the eastern state border, from 2019 to 2022, five new autochthonous HAE cases were diagnosed, all concentrated in the Bjelovar-Bilogora County (the county incidence in 2019 and 2021: 0.98/105, in 2022: 2.94/105/year; prevalence for 2019–2022: 4.91/105). The age range among four female and two male patients was 37–67 years. The patients’ liver lesions varied in size from 3.1 to 15.5 cm (classification range: P2N0M0–P4N1M0), and one patient had dissemination to the lungs. While there were no fatalities, postoperative complications in one patient resulted in liver transplantation. In 2018, the overall prevalence of red foxes was 11.24% (28/249). A new focus on HAE has emerged in central continental Croatia, with the highest regional incidence in Europe. Screening projects among residents and the implementation of veterinary preventive measures following the One Health approach are warranted