Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive Models.

Liver transplantation (LTx) is the best treatment for patients with early-stage hepatocellular carcinoma (HCC). The Milan criteria positively influenced results of liver transplantation and were adopted by the majority of cancer centers, becoming the criterion standard treatment for early-stage HCC. Despite the use of restrictive criteria, recurrence is still high, affecting between 8% and 20% of cases, and is a significant predictor of survival after LTx. The diagnosis of both micro-and macro-invasion of vessels, which are significant factors in determining the frequency of recurrence and overall survival, significantly decreases the success of transplantation, causing an increase in mortality of 50% in comparison to recipients with no vascular invasion. The risk of recurrence depends on several factors, which are discussed in this review. The authors also discuss the clinical presentation and treatment methods of recurrence and its prognosis. In addition, the role of different models developed to identify groups of patients with high versus low risk of recurrence is discussed, enabling the planning of recommendations and screening protocols after transplantation to help early diagnosis and guide effective treatment. In the era of an increasing numbers of liver transplants due to HCC, the need to create robust screening tools is urgent.

Knowledge, Opinions, and Attitudes of Students of Warsaw Universities Toward Hematopoietic Stem Cell Transplantation.

BACKGROUND: Hematopoietic stem cell transplantation is a method of treatment in many diseases, including oncology. For a large group of patients, such a therapy is a procedure that saves their health and life. Most of the transplants come from unrelated donors, which are still insufficient in comparison to the recipients in need. The purpose of the study to assess the knowledge, opinions, and attitudes of students of Warsaw universities toward hematopoietic stem cell transplantation. METHODS: The survey was conducted among 351 students of Warsaw universities. The research method was a diagnostic survey, and the tool was the author's questionnaire. The statistical analysis was performed using the StatSoft Statistica 13.1 PL statistical package and Microsoft Office package. RESULTS: The respondents answered correctly on an average 59% of the analyzed issues. Medical students older than 25 and women had a higher level of knowledge; 41.6% of respondents were registered in the donor database, and this more often referred to medical students (P < .0001). The motivation for registering (97.3%) was the willingness to help another person. The unregistered reported that their lack of a decision on registration, among others, was because their general health condition made it impossible to become a donor (34.6%) or they had insufficient knowledge (31.7%)-this more often referred to nonmedical students (P < .0001). In addition, 55% of students would be interested in attending a meeting/lecture at their university about being a potential donor (including 63.1% of medical and 44.9% of nonmedical students). CONCLUSIONS: The knowledge of the surveyed students was at an average level, and the opinions and attitudes were mostly favorable. It seems that the organization of meetings on bone marrow donation at universities could enable a larger number of undecided students to decide to enter into the donor register.

Surgical Site Infections in Liver Transplant Patients: A Single-Center Experience.

AIM: The aim of the study was a single-center assessment of occurrence of surgical site infections (SSI) in patients after liver transplantation and an attempt to determine factors that may contribute to this complication. PATIENTS AND METHODS: Analysis of medical records of 60 adult patients, who underwent first transplantation in 2016 and 2017 was conducted. Selected pre-, intra-, and postoperative factors were assessed. Statistical analysis was performed with StatSoft Statistica 13.1 PL package. RESULTS: SSI occurred in 25% of liver recipients, with average timing of diagnosis on the 14th day after surgery. Mean duration of hospitalization was significantly longer in patients who experienced SSI than in patients without this complication (35.8 ± 8.9 days vs 25.2 ± 6 days, P < .0001). SSI occurred a little more frequently in men and older recipients, as well as in overweight and underweight patients (not significant). An indication for transplantation did not have an impact on SSI occurrence. The complication was more likely in patients with diabetes and renal failure prior to transplantation (P > .05). Duration of the procedure, blood loss and prolonged drainage did not have any impact on SSIs. SSI was significantly more common in recipients with lower total protein value (P < .0002) and anemia (P < .0002) in early postoperative period. CONCLUSION: Among the studied population, a high incidence of SSI was noted, and that some of the identified risk factors differ from those described in the literature.

Nursing Problems in Care of a Patient with Very Early HCV Infection Recurrence After Liver Transplantation: A Case Report.

BACKGROUND Recurrent HCV infection following liver transplantation is a common problem, and usually has a more aggressive course than primary infection. The aim of the paper was to present nursing problems in the care of a 22-year-old female patient after liver transplantation (Ltx) with a rapid recurrence of HCV infection shortly after Ltx. CASE REPORT Ltx was performed 22 July 2012 due to chronic cirrhosis secondary to HCV infection with viremia (HCV PCR 3.5×107 IU/mL). Graft function worsened 14 days following transplantation. Acute cholestatic hepatitis related to HCV reinfection was diagnosed based on biopsy. During a period of 20 months the patient received 3 different antiviral treatment regimens, beginning with a dual therapy (Interferon and Ribavirin), followed by the inclusion of Telaprevir, then Daclatasvir; however, these treatments were not successful. The fourth-line regimen with sofosbuvir (EU medical experiment) led to viremia elimination (HCV PCR) after 5 weeks of treatment. However, hepatic failure stabilization was unsuccessful, there was an increase in encephalopathy, and the MELD score was 25. Therefore, the patient underwent liver retransplantation. In the post-transplantation period, the patient was in good condition, with no viremia. CONCLUSIONS The most common nursing problems in the care of the patient were associated with the diagnostic process, therapies used (including experimental treatment), and progressive liver failure. The therapeutic success should be attributed to the intensive supervision and monitoring of viremia, immediate inclusion of adequate treatment methods, adequate patient preparation for diagnostic tests, and careful care after diagnostics, as well as psychological support and education.