Bioprosthetic valve thrombosis and degeneration following transcatheter aortic valve implantation (TAVI).

Bioprosthetic valve thrombosis (BPVT) is a recognised complication of prosthetic aortic valves and can be found in up to 13% of patients after transcatheter implantation. The mechanism of BPVT is not well known, abnormal flow conditions in the new and native sinuses and lack of functional endothelialisation are suspected causes. BPVT may result in valve dysfunction, possibly related to degeneration, and recurrence of patient symptoms, or remain subclinical. BPVT is best diagnosed at multiphase gated computed tomography (CT) angiography as the presence of reduced leaflet motion (RELM) and hypoattenuating aortic leaflet thickening (HALT). Although CT is used to exclude BPVT in symptomatic patients and those with increased valve gradients, the value of screening and prophylactic anticoagulation is debatable.

PAR-1 antagonist vorapaxar favorably improves global thrombotic status in patients with coronary disease.

To assess the effect of vorapaxar on global thrombotic and thrombolytic status. The propensity for thrombus formation is determined by the balance between prothrombotic factors and endogenous thrombolysis. Impaired thrombolytic status increases cardiovascular risk. Vorapaxar is a novel, oral, protease-activated receptor-1 antagonist that inhibits thrombin-induced platelet activation. In the TRACER and TRA 2°P-TIMI 50 studies, patients with acute coronary syndromes and established atherosclerosis were randomized to vorapaxar 2.5 mg daily or placebo, in addition to standard care. In 57 patients enrolled in a single center, blood was tested with the point-of-care global thrombosis test, on and off treatment. This automated test employs non-anticoagulated blood to assess thrombotic and thrombolytic status, measuring the time required to form a shear-induced thrombus under physiological conditions (occlusion time, OT), and subsequently, the time to achieve endogenous lysis of the thrombus (lysis time, LT). Patients on vorapaxar exhibited longer OT on vs. off treatment [median 561 s (interquartile range 422-654) vs. 372 s(338-454), P = 0.003] and shorter LT on treatment than off [1,158 s(746-1,492) vs. 1,733 s(1,388-2,230), P = 0.016]. Patients on placebo showed no difference in OT [419 s(343-514) vs. 411 s(346-535), P = 0.658] or LT [1,236 s(985-1,594) vs. 1,400 s(1,092-1,686), P = 0.524] on and off treatment. During treatment, OT was longer in patients taking vorapaxar [561 s(422-654) vs. 419 s(343-514), P = 0.009], but LT was similar in vorapaxar and placebo arms [1,158 s(746-1,492) vs. 1,236 s(985-1,594), P = 0.277]. Vorapaxar prolongs OT and shortens LT, with favorable effects on thrombotic and thrombolytic status. In addition to its antiplatelet effect, vorapaxar may enhance endogenous thrombolysis, which is frequently impaired in coronary disease.

Abdominal Compartment Syndrome After Liver Transplant in Drug-Induced Acute Liver Failure: A Case Report.

The incidence of drug-induced acute liver failure (ALF) has been increasing in recent years. Despite the complex intensive treatment, liver transplant should be performed in progressive cases. A systemic inflammatory response syndrome and the burden of surgical intervention promote abdominal compartment syndrome (ACS); observed preoperatively, they are significant negative prognostic factors. THE CASE: We demonstrate a young woman with liver transplant after ALF and a consecutive ACS. We presumed drug toxicity in the background of the rapidly progressive ALF, based on the preoperative hematologic examination and the histology of the removed liver. An ACS has occurred in the postoperative period that must have been resolved with mesh, and later, anatomic segment 2-3 resection had to be performed to further decrease the pressure. The patient left the hospital after 62 days with good graft function. DISCUSSION: A complex intensive care is mandatory in the case of orthotopic liver transplant for ALF. Outcomes are good after orthotopic liver transplant. An ACS might occur after surgery. In these rare cases a delayed abdominal closure or even a liver resection can be the only solution and sometimes an urgent need to resolve the life-threatening problem.

Management of Portal Hypertension After Liver Transplantation.

INTRODUCTION: Post-transplantation portal hypertension has severe complications, such as esophageal varix bleeding, therapy refractory ascites, extreme splenomegaly, and graft dysfunction. The aim of our study was to analyze the effectiveness of the therapeutic strategies and how to visualize the procedure. METHODS: A retrospective study involving liver transplantation patients from the Semmelweis University Department of Transplantation and Surgery was performed between 2005 and 2015. The prevalence, etiology, and leading complications of the condition were determined. The applied interventions' effects on the patients' ascites volume, splenic volume, and the occurrence of variceal bleeding were determined. Mean portal blood flow velocity and congestion index values were calculated using Doppler ultrasonography. RESULTS: The prevalence of post-transplantation portal hypertension requiring intervention was 2.8%. The most common etiology of the disease was portal anastomotic stenosis. The most common complications were esophageal varix bleeding and therapy refractory ascites. The patients' ascites volume decreased significantly (2923.3 ± 1893.2 mL vs. 423.3 ± 634.3 mL; P < .05), their splenic volume decreased markedly. After the interventions, only one case of recurrent variceal bleeding was reported. The calculated Doppler parameters were altered in the opposite direction in cases of pre-hepatic versus intra- or post-hepatic portal hypertension. After the interventions, these parameters shifted towards the physiologic ranges. CONCLUSION: The interventions performed in our clinic were effective in most cases. The patients' ascites volume, splenic volume, and the prevalence of variceal bleeding decreased after the treatment. Doppler ultrasonography has proved to be a valuable imaging modality in the diagnosis and the follow-up of post-transplantation portal hypertension.

Examinations of Factors Influencing Survival of Liver Transplantation for Hepatocellular Carcinoma: A Single-Center Experience From Budapest.

INTRODUCTION: Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death worldwide. Orthotopic liver transplantation (OLT) is the best therapy of choice for early, unresectable HCC. The Hungarian Liver Transplantation Program was launched in 1995 at the Department of Transplantation and Surgery, Semmelweis University, Budapest. From that time more than 60 patients underwent OLT for hepatic tumors, which in most cases were HCC. Our clinical examination was undertaken to analyze the possible influential factors of outcomes for our series of patients who received OLT for HCC. METHODS: We performed a review of all patients who underwent OLT for HCC at our department from 1996 to October 1, 2013. Disease extent was determined by preoperative computed tomography or magnetic resonance images. All explants were examined and categorized based on tumor number, size, distribution, HCC histologic grade, and vascular invasion. Patients with HCC were classified as having tumors either meeting Milan criteria, beyond Milan criteria but within UCSF criteria, or exceeding UCSF criteria. OLT was performed using standard techniques including orthotopic implantation with cross-clamp technique or with the piggyback technique. Postoperative immunosuppression included a triple drug regimen of calcineurin inhibitor (CNI), mycophenolate mofetil (MMF), and prednisone. mTOR inhibitors have been available since 2004. RESULTS: HCC most commonly occurs in the presence of cirrhosis as a result of longstanding chronic liver disease. Most of our patients who underwent OLT for HCC are 56 to 60 years old, and most also had underlying HCV cirrhosis. As of October 1, 2013, 21 of 49 (42.85%) patients had died after OLT for HCC. The main cause was the recurrence of the HCC in 38%, followed by sepsis in 33%, and HCV recurrence in 19%. One death each (4.7% of the total number of deaths) was caused by primary nonfunction of the graft, acute myocardial infarct, and de novo malignancy, respectively. Overall survival for the entire group at 1, 3, and 5 years after transplantation was 73.48%, 65.2%, and 50.08%, respectively. Using pretransplant imaging, 34 tumors (69.3%) were within Milan criteria, 8 (16.3%) were beyond Milan but within UCSF criteria, and 7 (14.3%) exceeded UCSF criteria. Based on explant pathology, 30 tumors (61.2%) were within Milan criteria, 7 (14,3%) were beyond Milan but within UCSF criteria, and 12 (24.3%) exceeded UCSF criteria. New onset, non-HCC malignant tumor developed in 2 cases (4%). There was no significant difference between the surgical techniques or the immunosuppressive strategies. Using the Cox analysis in our series, it can be seen that mortality was higher with tumors exceeding Milan criteria but within UCSF criteria compared with tumors within Milan criteria (Coef. = 0.5749 in Setting 1 and 0.1226 in Setting 2), and even higher with tumors beyond UCSF criteria compared with tumors within Milan criteria (Coef. = 0.7228 in Setting 1 and 0.1456 in Setting 2). Recurrence of the tumor causes higher mortality (Coef. = 1.709 in Setting 1 and 1.0256 in Setting 2). It seems that using an mTOR inhibitor has a beneficial impact on mortality (Coef. = -1.409 in Setting 1). Vascular invasion was associated with higher mortality (Coef. = 0.6581in Setting 1). Higher AFP levels correlated with higher mortality but not significantly (Coef. = 0.0002 in Setting 2). In our series, survival after OLT for HCC was best with tumors within Milan criteria comparing those exceeded Milan criteria (odds ratio = 4.000). CONCLUSION: According to our findings, the Milan criteria are still the safest criteria system; however, slightly expanded criteria do not have significantly worse results. Preoperative imaging methods sometimes show fewer or smaller tumors, and the explant histology reports the exact staging of HCC at the time of OLT. Histological examination especially of the lymphovascular invasion is mandatory to assess the estimated prognosis. Extremely high levels of AFP mean higher risk. HCC recurrence is an important factor on the outcome; therefore, continuous oncologic screening is mandatory. Immunosuppressant agents are chiefly responsible not just for higher risk of recurrence but for higher risk to develop de novo malignancies. Viral serology must be done periodically to catch HCV recurrence in time and begin adequate antiviral therapy. Potentially, mTOR inhibitors could be potent immunosuppressive agents after OLT for HCC due to this antiproliferative effect.

Analysis of Incretin Hormones After Orthotopic Liver Transplantation.

BACKGROUND: Several well-known risk factors play an important role in the development of new-onset diabetes mellitus after orthotopic liver transplantation (OLT). Immunosuppressant drugs and hepatitis C virus (HCV) infection have a direct effect on pancreatic beta cells resulting insulin hyposecretion. Steroids mainly cause peripheral insulin resistance. Although in type 2 diabetes mellitus the incretin-insulin axis is impaired and incretin hormones are advantageous targets of many antidiabetic drugs, the endocrinologic background of new-onset diabetes mellitus after transplantation (NODAT) is still not completely understood. METHODS: During the first postoperative year the oral glucose tolerance test (OGTT) was performed on 21 patients after OLT. Patients' glycemic metabolic status was determined according to the results of OGTT. The level of incretin hormones, namely glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP), were measured with competitive enzyme-linked immunoassay reaction. RESULTS: Six patients had normal glucose tolerance (NGT), 9 had impaired glucose tolerance (IGT, serum glucose 7.8-11.0 mmol/L), and 6 were diagnosed with NODAT (serum glucose >11.1 mmol/L). Fasting insulin and c-peptide levels were higher if IGT/NODAT was found. Insulin secretion was not further stimulated after OGTT. GIP and GLP-1 levels did not differ significantly, not even after glucose load. HCV infection had not influenced the levels of incretin hormones [GLP-1 (0 min): 1.21 ± 0.27 vs 1.38 ± 0.65; P = ns; GLP-1 (120 min): 1.46 ± 0.61 vs 1.07 ± 0.58; P = ns; GIP (0 min): 2.55 ± 0.95 vs 1.99 ± 0.63; P = ns, GIP (120 min): 2.62 ± 0.6 vs 2.33 ± 0.77; P = ns]. CONCLUSION: The stimulation of insulin secretion in NODAT is limited. Incretin hormones are present independently from the current glycemic status. The use of dipeptidyl peptidase-4 inhibitors through their positive effect on the incretin-insulin axis can be beneficial in the therapy of NODAT after liver transplantation.

Activation of the phagocytic system increases intimal proliferation in hypercholesterolemic rabbits.

The effect of in vivo stimulation of the phagocytic system (neutrophils, monocytes and hepatic Kupffer-cells) by inducing phagocytosis of intravenously administered latex particles on lipid peroxidation and aortic intimal proliferation was tested in cholesterol-fed rabbits. Three weeks after starting the diet, aortic intimal proliferation was measured by the intimal to medial ratios and by the incorporation of [3H]thymidine, infused into the circulation for the preceding 14 days. Intimal to medial ratios were increased (0.473 +/- 0.023 vs. 0.282 +/- 0.011, P < 0.01) and aortic [3H]thymidine contents were higher (66.8 +/- 3.5 vs. 27.8 +/- 49 counts/min per mg, P = 0.0001) in latex bead-treated than in control animals. Injection of beads transiently increased plasma lipid peroxide levels. At the end of the 3 week experiment, plasma lipid peroxide levels were still elevated and lipid peroxide contents of the aortic walls were higher in the latex-treated rabbits (82.8 +/- 5.8 vs. 46.4 +/- 4.9 nmol/mg cholesterol, latex-treated vs. controls, P = 0.004). These data suggest a significant acceleration of atherogenesis by the stimulated phagocytic system, the mechanism of which may involve lipid peroxidation.

Thrombotic status analyser. Measurement of platelet-rich thrombus formation and lysis in native blood.

A physiologically relevant global in vitro test is described which allows the overall assessment of both thrombotic and thrombolytic activities of blood. In principle, native blood is drawn in pulses through a capillary tube where haemodynamic forces induce a platelet reaction culminating in vessel occlusion. Dislodgement/disintegration of the stabilised thrombus under pressure is a reflection of thrombolysis. Evidence is presented for the platelet-rich nature of the occlusion and that disruption of the thrombus and re-established patency is the result of thrombolysis, that is fibrinolysis with significant contribution from platelets. This test sensitively detects hypercoagulability (stasis); platelet hyperreactivity (coronary artery disease); anti-platelet effect (aspirin, prostacyclin) and the thrombolytic effect of, thrombin generation by, and resistance to streptokinase. Therefore, this overall assessment of thrombotic status could be of great diagnostic and therapeutic benefit in clinical practice.

Vasomotor responses of coronary stenoses to acetylcholine and their relation to serum lipid levels in stable angina pectoris.

The effects of acetylcholine administration on coronary stenoses in relation to serum lipids level were evaluated in 18 patients (15 men, 3 women) with coronary artery disease and stable angina. Intracoronary acetylcholine was infused in concentrations 10(-7), 10(-6), 10(-5) M, followed by intracoronary bolus administration of isosorbide dinitrate. Computerized angiography was used to assess the changes in the diameter of stenoses and of proximal and distal segments. During acetylcholine infusion, at concentrations between 10(-7) to 10(-5) M, there was a significant (p <0.01) dose-dependent constriction of proximal and distal segments and of stenoses reversed by isosorbide dinitrate. There was no correlation between the serum total cholesterol level and the responses of proximal and distal segments to acetylcholine or nitrate. A correlation (p <0.05) was found between the serum total cholesterol level and the response of stenoses to acetylcholine, but there was no correlation with the response to isosorbide dinitrate. In conclusion, in patients with stable angina current serum total cholesterol level correlates with the vasomotor response of coronary stenoses to intracoronary acetylcholine. These findings are consistent with a direct effect of cholesterol, increasing basal coronary vasomotor tone and increasing the stimulated vasoconstrictor response of stenoses.

Raised factor VIII is associated with coronary thrombotic events.

Coagulation is triggered during the onset of myocardial infarction, resulting in vascular occlusion. However, a causal role for individual haemostatic factors in the development of thrombotic occlusion is not established. Three cases (all relatively young women) are reported of raised factor VIII associated with myocardial infarction. Two patients presented acutely with myocardial infarction at a relatively young age with no preceding history of angina. The other patient had had venous thrombosis when young and activated protein C resistance (APCR), without the presence of factor V Leiden. A functional relation exists between APCR and factor VIII; therefore, raised factor VIII may contribute to APCR and the increased thrombotic risk in patients without factor V Leiden. Factor VIII is an important risk factor for atherothrombotic events, including sudden death, in patients with vascular disease. These cases support the association of raised factor VIII with acute thrombotic events, even in patients without significant underlying atheromatous disease.

Treatment of iatrogenic aortic dissection by percutaneous stent placement.

During elective cardiac catheterization via the right femoral artery, difficulty was encountered advancing the guidewire beyond the aortic arch and the procedure abandoned. The patient later developed back pain and hypotension. A contrast-enhanced spiral computed tomography scan confirmed aortic dissection, extending from an entry point in the external iliac artery to the arch. We hypothesized that the entry site was responsible for filling the dissection in the thoraco-abdominal component. A stent was placed in the iliac artery, occluding the entry point. This is the first report of aortic dissection, a rare complication of angiography, managed by percutaneous stenting of the entry point.

[Initial experience with ultrasonic examination of the rectum]. / Kezdeti tapasztalataink a rectum ultrahang vizsgálatával.

The authors report their initial results obtained by the use of transrectal sonography in examination of known or suspected rectal and perirectal masses. 42 patients were examined with commercially available endosonographic probes. 22 patients had known rectal cancer. 13 patients underwent surgical exploration. Malignant infiltration of perirectal fat were detected as accurately with US as with histology in 9 cases. Lymph node involvement was accurately identified in 11 cases. They recommend this new technique for the assessment of invasion of rectal tumours and lymph node involvement, for postoperative follow-up and for examination of benign diseases of the rectum.

[The role of local excision in the surgical treatment of rectal cancer]. / A localis excisio helye a végbélrák sebészi kezelésében.

UNLABELLED: Between 1984 and 1992 authors performed 307 surgical interventions for patients with rectal cancer, of these 199 operations were curative (65%). Local excision of the tumour was carried out in 9 cases: 2 with palliative intent, 7 were considered a curative treatment, that constituted 3.5% of all curative procedures. Five tumours were removed by transanal local excision, 2 located in the upper part of the rectum required laparotomy and rectotomy. No operative mortality. One wound sepsis was registered after laparotomy. There was one local recurrence after removing the primary tumour. At the same time 83 patients suffering abdominoperineal resection or anterior resection had tumour limited to the rectal wall without lymph node metastasis. The mortality was 1.4%, the morbidity 28% and local recurrence rate was 19% in this group. The difference between the the results of the two groups did not achieve statistical significance included the survival too. Of the 83 tumours removed by more radical operations 38 located between 1-8 cm from the anal verge. Excluding tumours poorly differentiated and those with diameter larger than 3 cm, 17 rectal cancer would have been suitable for transanal local excision, that constitutes 8.5% of the curative operations. CONCLUSION: with more accurate preoperative staging the transanal local excision for carcinoma of the rectum can be performed more frequently than earlier. The risk of the operation is lower than those of the abdominoperineal or anterior resection and the late results are comparable if strict selection criteria are implemented.

[The effect of blood transfusion on the late results of the surgical treatment of rectal cancer]. / A transzfúzió befolyása a végbélrák sebészi kezelésének késói eredményeire.

UNLABELLED: Prospectively recorded data of 149 patients undergoing curative resection for rectal cancer between 1985-1992 were evaluated. Survival rate and tumor recurrence were studied in transfused and non-transfused groups of patients. There wasn't statistically significant difference found between the two groups concerning the 5 year survival rate (53 and 59%). Whole blood had more deleterious effect on survival than packed red cells (48 versus 61%), but the difference didn't reach the statistical significance level. The 5 year survival rate of patients without transfusion was significantly higher (p < 0.05) than those received > 800 ml of blood (59 v.s. 33%). The tumor recurrence wasn't associated with transfusion. Neither the quality, nor the amount of blood seems to influence on the recurrence rate significantly. In the group of patients with > 800 ml of transfusion the lower preoperative hematocrit, the higher rate of abdominoperineal resection of the rectum and the longer duration of surgery than those of patients nontransfused reflect the unfavorable tumor stage and the difficulties in removing the tumor. Authors believe these circumstances necessitating the transfusion may be responsible for worse outcome of rectal cancer but the immunosuppressive effect of the blood can't be excluded. CONCLUSIONS: stricter indication than earlier is necessary for administration of blood transfusion to patients with rectal cancer to decrease the risk of transfusion-transmitted infections and to avoid the possible immunosuppressive effect of the blood. Packed red cells is preferable. Decreasing volume of perioperative homologous transfusion by improving surgical technique and clinical application of autologous transfusion should be considered.

[Severe relapse of hepatitis C following liver transplantation. Successful treatment with a combination of interferon-alpha and ribavirin]. / Hepatitis C súlyos relapsusa májátültetés után. Sikeres kezelés interferon-alpha és ribavirin kombinációval.

A 38-year-old, male patient, with end-stage HCV cirrhosis, underwent liver transplantation (OLT). After a sufficient recovery a rapid elevation of ALT and profound jaundice developed 3 months after OLT, together with a 15-fold rise of pre-transplant HCV RNS level. Liver biopsy was carried out, histology excluded rejection and signs of acute hepatitis were observed. Interferon alpha 2b 3 MU TIW and ribavirin 800 mg/day resulted in normalization of ALT, se. bilirubin and decrease of viral load by 90 per cent at the 3rd month of treatment. Improvement of hepatitis and no rejection was shown by control histology. A 6-month combination therapy followed by continuous ribavirin monotherapy maintains a permanent good condition with normal ALT, no icterus, a continuously low HCV RNA level and a mild chronic hepatitis with fibrosis in the liver histology 18 months after OLT. Danger of HCV reactivation after OLT, difficulties of diagnosis, interactions of immunostimulant and immunosuppressive drugs, advantages of combination therapy are discussed.

[Viral screening of organ donors and human cytomegalovirus seroprevalence in the Hungarian population]. / Szervdonorok virológiai szúrése és a hazai lakosság átfertózöttsége human cytomegalovirussal.

The authors investigated 998 organ-donors for Human cytomegalovirus seroprevalence. The donors were divided into three age-groups. In organ-donors the seroprevalence was found to be 84%. A study was also conducted on a fourth group consisting of 200 residents from an old-age home. The youngest donor was 2 years of age, the eldest old-age home resident was of 92 years. The examined persons represent the hungarian population. It was found that as the result of the investigation of all 1198 subjects, the Human cytomegalovirus overall seroprevalence in Hungary is 86%. The age specific prevalence increases starting from 73% in the first group (2 to 20 years old) to 99% in the fourth group (71 to 92 years old). This has indicated that most of the population acquired the primary infection in the childhood or during early adulthood. According to these results the authors resumed that in Hungary the Human cytomegalovirus seroprevalence is high. This would cause problems when a seronegative organ-recipient needs an organ transplantation. Between males and females a significant difference of Human cytomegalovirus seroprevalence was found: 89% of females were seropositive in contrast to 81% of males (p < 0.05). The organ-donors were also examined for the presence of HBsAg, anti-HCV and anti-HIV. 1.8% of donors were HbsAg positive, 0.9% were anti-HCV positive and 1 person was anti-HIV positive, but these results weren't verificated.

[Availability of livers from cadaver donors in Hungary]. / Cadaver donorból származó máj elérhetösége Magyarországon.

The availability of cadaver livers for transplantation have been studied based on data recorded prospectively by authors. Between January 1, 1995 and August 31, 1995, 98 cadaver kidney donors were accepted in Hungary. Using well established selection criteria 52 of them could have been suitable for liver donation. Steatosis or cirrhosis of the donor livers have been considered most frequent causes of unsuitability for transplantation. Based on these data 70-75 cadaver livers could be transplanted yearly in Hungary that's enough to start a transplant program. The treatment of acute hepatic failure with transplantation seems to be uncertain because of unequal time and blood group distribution of donors. There are just few available cadaver livers for children therefore transplantation of reduced sized liver is needed.

[Small intestinal leiomyoma causing gastrointestinal hemorrhage]. / Emésztórendszeri vérzést okozó vékonybél leiomyoma.

Leiomyomas are uncommon benign tumors of smooth muscle which may occur wherever smooth muscle is present. The small bowel is the most frequent site. Bleeding is the most common presenting symptom. Other symptoms, nausea, vomiting, abdominal pain are rare. In this article a 44 year-old male, presented, who was admitted with intermittent gastrointestinal bleeding in requence of jejunal leiomyoma with exulceration.

[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.

[Experience gained from the organization of the first group of patients who benefited from liver transplantation]. / Tapasztalatok a májátültetéssel gyógyítható betegek elsö csoportjának szervezésével.

The authors report in this ciency in the majority of the cases was alcohol abuse or article about their experiences, how could they select a small group of patients awaiting liver transplantation since September 1994. The cause of the liver insuffiHCV infection. During 37 weeks 3 liver transplantations were performed and 5 patients died on the waiting list. (15,6% of the patients on the waiting list.)