Successful islet after kidney transplantations in a distance over 1000 kilometres: Preliminary results of the Budapest-Geneva collaboration.

To overcome critical islet processing and to ensure patient safety and quality care, we have established an international collaboration between two geographically distant transplant centers for islet transplantation. Four pancreata were harvested and immediately preserved by the two-layer method (oxygenated perfluorocarbon+University of Wisconsin) and subsequently transported for the automated method isolation to Geneva. After purification, the islets were cultured overnight and transported the next day back to Budapest. Three consecutive kidney transplant patients with type 1 diabetes mellitus underwent islet transplantation via percutaneous transhepatic portal embolization using the bag-method. The immunosuppression consisted of daclizumab, sirolimus, and low-dose tacrolimus. Mean donor age was 43.7 years, mean body mass index: 26.5. The islet isolation process began within 8 hours from the donor aorta cross-clamp in all cases. The isolation success rate was 80% (4 of 5). In Budapest, the islets were assessed for viability. No complications occurred during the transplantation, and the portal pressure remained within the normal range. The first patient received 12,000 IU/BW from two donors and the insulin requirement decreased from 40 U/d to 10 U/d. The second patient received 7200 IU/BW from a single donor and became immediately insulin free. The third patient was given 7100 IU/BW; the insulin requirement decreased from 39 U/d to 14 U/d. Posttransplant follow-up for the three patients are 7 months, 4 months, and 2 weeks, respectively. All patients achieved metabolic stability. These preliminary results demonstrate the feasibility of an international collaborative islet transplantation program at a distance over 1000 km.

[Pathologic evaluation of orthotopic liver transplantation in Hungary]. / A hazai májtranszplantációk értékelése patológiai szempontból.

A total of 81 orthotopic liver transplantations were performed on 74 patients between January 1995 and December 1999 at the Department of Transplantation and Surgery of the Semmelweis University in Budapest. Indication for transplantation was liver cirrhosis in 57 cases, 10 patients were transplanted due to fulminant liver failure, while 7 patients underwent transplantation because of liver metastasis of different semimalignant tumours. During the above period, retrospective studies on 205 pre- and posttransplantation liver biopsies, 74 explanted livers, 7 explanted liver grafts and 22 autopsy cases were performed at the First Institute of Pathology and Experimental Cancer Research of the Semmelweis University in Budapest. A number of 116 protocol biopsies (dates as zero time, 7th day, 6th month and 12th month) and 73 non-protocol biopsies (taken due to liver allograft dysfunction) were analysed. Different gradings of acute rejection--characterised by trias of portal inflammation, venous endothelitis and bile duct damage--were detected in 62 cases. Chronic rejection occurred in 7 patients, with 4 cases of vanishing bile duct syndrome and one of the case of foam cell arteriopathy, add to 2 cases of chronic rejection characterized by undetermined bile duct damage. The present study includes the evaluation of 22 autopsy cases according to liver transplantation in Hungary, with the finding that liver allograft insufficiency was the main cause of mortality. Authors conclude that pathomorphological analysis has an important role in relation to liver transplantation.

[Initial experience with ESWL therapy of pancreatic duct calculi]. / A pancreas vezetékkövek lökéshullám (ESWL) kezelésének kezdeti tapasztalatai.

Extracorporeal shock wave lithotripsy of pancreatic stones was performed in four patients with chronic pancreatitis and a dilated duct system harbouring stones 5-12 mm in diameter. The stones were disintegrated by shock waves using a Dornier lithotripter in one or more sessions. Disintegration of stones was achieved in 4/4 patients, initial (6-11 months) relief of pain in 3/4 patients, and total clearance of pancreatic duct in 3/4 patients. No complications were observed. In the first patient in whom ESWL was not completely successful, underwent an operation: a longitudinal pancreato-gastrostomy and the stones were found completely disintegrated. From these early data they conclude that ESWL of pancreatic duct stones is a provisional new alternative for surgery in the treatment of chronic pancreatitis.

[Ultrasonic diagnosis with secretin stimulation in patients with pancreas divisum]. / Secretin stimulációval végzett ultrahang vizsgálat pancreas divisumban.

The diagnostic value of secretin provoked abdominal ultrasound was studied on 34 patients with pancreas divisum and on 20 control subjects. The patients received a 1.0 unit/kg body weight dose of secretin. The degree of ductal expansion and the time required to return to the initial state were registered and these values were compared to the clinical diagnosis. The control subject's ductal diameters prior to secretin administration were 1 mm in all cases (maximum expansion 2 mm, return to the initial value within 10 minutes). The pancreas divisum patients could be placed in two groups based on their initial ductal diameter. Fourteen patients had initial ductal diameters of 2 mm or greater (A group mean +/- SD: 2.4 +/- 0.3) while 21 patients had an initial value of less than 2 m (B group; 1.7 +/- 0.3). Following secretin administration the ductal diameter of the A group's patients increased on average +/- SD to 1.3 +/- 0.5 times the initial value and in the B group 3.2 +/- 1.1 times the initial value (p less than 0.01). In the A group the ductal diameter returned to its initial value within 10 minutes, while it took 35 minutes for the same to occur in the B group. A relationship can be observed between the clinical diagnosis, the initial ductal diameter, the degree of expansion following secretin administration and the time required to return to the initial state.

Duplex ultrasonography in portal vein thrombosis.

Duplex ultrasonography (US) was performed in 23 patients with portal vein thrombosis. In 7 children and 16 adults, duplex US demonstrated intraluminal thrombi (4 cases), thrombus and periportal collaterals (2 cases), and cavernomatous transformation of the portal vein (17 cases). Real-time US is a suitable means of demonstrating the anatomy of the portal venous system; pulsed Doppler provided information on the patency and direction of portal flow. In a few cases, Doppler color flow imaging was used, which was helpful in the examination of branches of the portal vein and the superior mesenteric and splenic veins. Portal duplex US is suggested in selected groups of patients before surgery to demonstrate the presence or absence of portal vein thrombosis.