1000 liver transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw--analysis of indications and results.

THE AIM OF THE STUDY: was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw. MATERIAL AND METHODS: Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival. RESULTS: The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations. CONCLUSIONS: Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.

Prevention of hepatitis B recurrence after liver transplantation using lamivudine and hepatitis B immune globulin.

BACKGROUND: Patients undergoing liver transplantation (ltx) for hepatitis B-related liver disease are prone to recurrence. Historically, ltx has been associated with aggressive reinfection and poor survival results. The mainstay of prophylaxis has been passive immunotherapy with hepatitis B immune globulin(HBIG). Antiviral prophylaxis with lamivudine appears to reduce hepatitis B virus (HBV)infection after liver transplantation. However, HBV recurrence remains common. This study retrospectively evaluated a single center's experience with cohort of patients who underwent ltx for HBV-related chronic and acute liver disease. We examined the effect of a combined of intravenous HBIG and lamivudine viral prophylactic therapy on HBV recurrence and the outcome of ltx. MATERIAL/METHODS: Eighteen patients underwent transplantation for HBV liver disease at our center. Before ltx all patients were HBsAg positive and 3 were HBV DNA positive. HBV recurrence was defined by HBsAg seropositivity after ltx. HBIG monotherapy was used in 2 (15%) patients, lamivudine monotherapy in 4 (31%), and lamivudine and HBIG combination in 7 (54%). Hepatocellular carcinoma was present in 1 patients. Maintenance immunosuppression regimens consisted of either a cyclosporine- or tacrolimus-based drug regimen. RESULTS: Overall 1-year and 3-years patient survival rates were 60% and 60%, respectively, and 1-year and 3-years graft survival was 60% and 60% respectively. Among 7 patients receiving receiving combination HBIG and lamivudine, one patient died. He was retransplanted 9 months after first transplantation secondary to biliary complication caused by late hepatic artery thrombosis. Of the 6 surviving patients, 4 patients currently have normal allograft function. Allograft dysfunction developed in two patients because of ischemic biliary strictures. Among seven patients, who received HBIG and lamivudine, one did not receive proper administration of the prophylactic regimen and graft became infected. Serologic HBV recurrence was diagnosed after 9 months after transplantation. CONCLUSIONS: Liver transplantation for HBV under combination viral prophylaxis results in good survival rates. A good outcome is possible after liver transplantation for HBV liver disease using HBIG dosed by pharmacokinetic parameters in combination with lamivudine. Viral prophylactic therapy has effectively reduced HBV recurrence and prolonged survival outcome.

Surgical and interventional radiological treatment of Budd-Chiari syndrome: report of nine cases.

BACKGROUND/AIMS: The authors present the methods and results of treatment of patients with Budd-Chiari syndrome. METHODOLOGY: From a group of 15 patients with Budd-Chiari syndrome, treated in our department from January 1996 to September 2001, nine patients (6 females and 3 males, aged from 23 to 45 years) were qualified for surgical or radiological treatment. In 3 of them the hepatic vein thrombosis resulted from untreated polycythemia. In the remaining 6 cases the etiology of thrombosis remained unknown. In four patients with dominating portal hypertension symptoms, a meso-caval H-type graft was created. Four patients with severe liver insufficiency were qualified for orthotopic liver transplantation; all of them were transplanted. In 1 patient a balloon dilatation of the right and middle hepatic veins orifices was performed during the diagnostic cavography. The follow-up period ranged from 4 months to 5 years. RESULTS: In 2 patients with Budd-Chiari syndrome of unknown etiology, the "H"-shunt remained patent, and the patients were free of ascites and splenomegaly. During the period of follow-up (more than 5 years) they remained free of symptoms and demonstrated acceptable liver function parameters. Doppler sonography revealed the partial recanalization of the venous system. In 2 polycythemic patients, the shunt thrombosed, which was the indication for orthotopic liver transplantation in one of them. The transplantation was performed, but was unsuccessful because of hepatic graft artery thrombosis. The retransplantation in this case was also unsuccessful. The remaining 3 patients transplanted for cryptogenic Budd-Chiari syndrome are alive and well, 4, 5 and 11 months after orthotopic liver transplantation. In the patient subjected to interventional radiological hepatic veins dilation, the vessels remain patent 26 months post-procedure. The patient is free from ascites. CONCLUSIONS: Shunt surgery and liver transplantation are the valuable methods of treatment in selected cases of Budd-Chiari syndrome. In patients with polycythemia, however, thrombotic complications may occur in spite of anticoagulant and chemotherapeutic treatment. Balloon dilatation may appear an alternative to surgical treatment, but it seems that its indications should be limited to a highly selected group of patients.