[Liver transplant outcomes in Brno]. / Výsledky transplantací jater v Brne

The first liver transplant in the former Czechoslovakia took place in Brno on 2 February 1983; the patient concerned has lived for more than 30 years with a normally functioning liver and is one of the longest surviving patients after a liver transplant in Europe. The Cardiovascular and Transplantation Surgery Centre (CTSC) in Brno has experienced an increased development in the area of liver transplants since the mid  1990s. At present, about 30 patients a year undergo a transplantation, with 451 liver transplants in total as of 31 December 2012. The primary indication concerns liver cirrhosis of various etiologies, with an increasing number of cases of cirrhosis resulting from hepatitis C. Urgent liver transplants (for acute liver failure or primary dysfunction of first liver graft) amount to 11% of cases. There were 18 retransplants performed as of 31 December 2012, with 50% five year survival. The primary graft dysfunction was present in 7 patients (i.e. 1.5%). The 1 year survival rate of all patients after a liver transplant performed in CTSC is 92%, 5 year survival rate is 80%, and 10 year survival rate is 71%. Currently the parameters such as recipients age, donors age, and transplant waiting time has been statistically increasing; small recipients with a body weight below 70 kg especially have to wait for a significantly longer period of time (waiting median of 178 days). In CTSC Brno 14 combined simultaneous transplants (13 transplants of liver + kidney and one combined simultaneous transplants of liver + heart + kidney in 2005) have been performed as of 31 December 2012.

[Liver transplants in tumours and alcoholic cirrhoses]. / Transplantace jater u tumoru a alkoholických cirhóz.

The treatment of hepatocellular carcinoma requires a multidisciplinary approach; liver transplant is suitable only in the minority of strictly selected patients. The CSTC Brno applies the so  called Milan criteria. As of 31 December 2012 the CSTC Brno performed liver transplants in 16 patients with hepatocellular carcinoma in cirrhosis, with a five year survival rate of 40% and a 10 year survival after transplant of 20%. It is a paradox that the longest living (30 years) patient of CSTC Brno underwent the transplant for a large fibrolamellar hepatocellular carcinoma, which emphasises the prognostic significance of the tumour histology -  criterion taken into account for practical reasons only in some indication schemes. Liver transplant for cholangiocarcinoma is no longer being carried out in CSTC. Five patients underwent this operation in the past and the longest living one survived for four years after the transplant. Benign liver tumours (adenomatosis, cystadenoma, hemangioma with compression symptoms) are rather rare indications and transplant results are positive. Four patients were transplanted for liver carcinoid, with one patient experiencing recurrence. The most frequent compact indication for liver transplant in CSTC Brno concerns alcoholic cirrhosis (24%, 108 patients); the survival rate of these patients after transplant is very good (81% 5 year survival and 68% 10 year survival). Likewise, efforts are made to select patients with a low risk of alcohol abuse after the transplant, which is, however, not very successful. The recurrence of some kind of alcohol abuse occurred in 26% transplanted patients, while seven died of alcoholic cirrhosis of the graft.

[Kidney transplantation from donors dying of methanol intoxication]. / Transplantace ledvin od dárcu zemrelých na intoxikaci metanolem.

INTRODUCTION: Intoxicated patients represent only a minimum of the total number of cadaveric donors; however, their significance within the transplant program in the Czech Republic has recently been emphasized in connection with the so-called methanol affair. MATERIAL AND METHODS: A retrospective analysis of methanol-poisoned patients who were declared brain-dead and subsequently underwent organ removal for transplantation purposes in the University Hospital Ostrava was performed. In cooperation with other transplant centres (Institute for Clinical and Experimental Medicine, Transplant Centre of the University Hospital Hradec Kráilové, Centre for Cardiovascular and Transplantation Surgery in Brno) the graft function, postoperative morbidity and mortality was evaluated. RESULTS: During the study period (since September 2012), organs from three brain-dead donors as a result of methanol intoxication were retrieved in the Transplant Centre of the University Hospital Ostrava. Subsequently, six kidneys were transplanted (3 males, 3 females). Postoperative complications occurred in two patients (33.3%), one patient died (16.7%). In one case (16.7%), the graft failed. None of the graft recipients developed clinical or laboratory signs of methanol poisoning. CONCLUSION: Death due to methanol intoxication is not a contraindication to organ donation, graft function and patient survival being comparable to organs from non-intoxicated donors.

[An overview of the results of renal transplantation in the Czech Republic]. / Piehled výsledku transplantací ledvin v Ceské republice.

Renal (kidney) transplantation is now a routine and the most successful form of renal replacement therapy. There is a long tradition of renal transplantation in the Czech Republic, The first was performed as early as 1961 in Hradec Kralove, and the programme as such was launched in 1966 with the first successful transplantation at the Institute of Experimental Surgery (later Institute for Clinical and Experimental Medicine, Prague). At present, transplantations are being performed at 7 transplantation centres (IKEM Prague, Centre for Cardiovascular and Transplantation Surgery Brno, Faculty Hospitals Hradec Kralove, Plzen, Olomouc and Ostrava and Faculty Hospital Motol for children). From the programme launch until the end of 2010, 8,761 renal transplantations were performed, 364 in 2010 alone. One-year patient and cadaver renal allograft survival, transplanted in the CR between 2000 and 2009, is around 95% and 92%, respectively, and 5-year survival is 87% and 81%, respectively. As of 31st December 2009, a total of 3,771 patients lived with functional renal allograft in the Czech Republic and the proportion of patients with irreversible renal failure treated with transplantation has recently been around 40%.

[Immunosuppressive therapy and its problems]. / Imunosupresivní terapie a její úskalí.

Immunosuppressive therapy is crucial for successful kidney transplantation. Induction, antirejection and maintenance immunosuppressive therapy are basic types of immunosuppressive therapy. Base of maintenance immunosuppressive therapy are corticoids + tacrolimus + mycofenolate mofetil. Short and long-term adverse effects are present. Drug interaction with macrolids and antimycotics are substantial. Cooperation between transplantologist and other specialists are crucial for adequate immunosuppressive therapy actualization. Lack of correlation and communication may lead to irrecoverable damage to transplanted kidney.

[Liver transplantation for hepatitis B]. / Transplantace jater pro hepatitidu B.

Up to now the outcomes of liver transplantation in patients with chronic viral hepatitis B have not been very good because the recurrence of viral hepatitis in the graft has been high and resulted in a high early graft failure of liver transplant recipients. However, the administration of a combined therapy with lamivudine and hyperimmune anti-HBs globulin has led to a marked improvement in transplantation results and an increase in the number of liver transplantations for this indication. Four men (aged 47 to 55 years) underwent liver transplantation for cirrhosis, caused by chronic viral hepatitis B, at our centre. All were HBsAg carriers. They were our first patients who received therapy with the combined immunoprophylactic regimen of lamivudine and hyperimmune anti-HBs globulin. HBV DNA negativity was achieved in all patients prior to transplantation; three of them were pretreated with lamivudine. At 4 to 17 months of follow-up, sustained suppression of HBV replication (HBV DNA negativity) was maintained in all four patients. No complications associated with this treatment were observed and no emergence of resistant mutants was detected. The combined therapy for chronic viral hepatitis B administered to liver transplant recipients at our centre showed very good outcomes. However, the development of resistant mutants during this therapy poses a problem, which may hopefully be overcome with the use of new antivirotics, such as adefovir or tenofovir.

[Renal transplantation--effective or useful?]. / Transplantace ledvin--efektní nebo efektivní?

In indicated cases the renal transplantations constitute a very effective method of solving the final renal failure. Their medical and economic importance is constantly increasing. They positively influence not only the quality of life, but also a morbidity and mortality of transplanted. It has been a long time since the comparison of annual financial costs per dialysed patient (in average 750,000 CZK) and transplanted one (in average 500,000 CZK in first year after transplantation, consequently 250,000 CZK per year) is known. Annual saving of 250,000 CZK or half a million crowns per patient with a functioning implant is a sufficiently expressive argument reflecting the effectiveness of these operations. If the total amount of patients with functional renal implant in our country is 2889, the possible saving of 1,4445 billion CZK is staggering. The quality of life after a succesful renal transplantation is incomparable with the life at the regular dialysis regime. It is documented not only by medical parametres, but mostly by the spontaneous manifestations and the evaluations made by the patients themselves. The renal transplantations are an effective and also a useful, standard method of the therapy of final renal failure in the contemporary medicine.

[Lipid disorders after organ transplantation]. / Poruchy lipidu po transplantacích orgánu.

Transplantations are a routine method of treatment of chronic and acute organ failure. Changes in the therapeutic strategy led to improvement of organ and patient survival immediately after transplantation and during the early post-transplantation period. Medium-term and long-term results of organ survival improved less markedly. Chronic dysfunction and death are the most frequent causes of loss of a transplanted organs one year after transplantation. Chronic dysfunction has immunological and non-immunological causes. An important risk factor is hyperlipidaemia. Therapy must be started as soon as possible. It threatens the patients prognostically more than the normal population. Dietetic treatment and optimal immunosuppression are essential therapeutic steps which have a favourable effect on the general prognosis. A great hope in transplantology are statins. They have not only a positive effect on blood lipids but also an immunosuppressive and antiproloferative effect which is very favourable for the prevention of transplantation vasculopathies. Most probably their group effect is involved. Statins combined with classical immunosuppressive preparations reduce the incidence of acute rejections. The effect on lipid levels, the frequency of rejections and development of vasculopathies makes statins important adjuvant preparations in transplantology.