Assessment of early biliary complications after orthotopic liver transplantation and their relationship to the technique of biliary reconstruction.

INTRODUCTION: Biliary complications are known as the weak point of liver transplantation. Their occurrence can be related to the practice of drainage of the biliary anastomosis, the routine use of which was abandoned in June 2004. The aim of the study was to assess the incidence and type of biliary complications following orthotopic liver transplantation in relation to the technique of biliary anastomosis. MATERIAL AND METHODS: We compared the results of two groups of adult liver transplant recipients: group I, recent 50 transplantations with biliary drainage (25 women: 25 men of age range: 17 to 63 years), and group II, first 50 transplantations without drainage (19 women and 31 men of age range, 20 to 65 years). We examined the problem of biliary complications and their influence on the further management of the patients. In both groups the main indications for transplantation were various types of cirrhosis as well as cholestatic diseases. In the majority of cases (n = 86) an end-to-end common bile duct anastomosis was performed and in 14 cases, hepaticojejunal anastomosis. RESULTS: In group I, biliary complications requiring surgical or endoscopic intervention occurred in 10 (20%) recipients. In one case, biliary complications resulted in the need for retransplantation. In group II, biliary complications occurred in only four (8%) patients, none of which caused organ loss. CONCLUSION: Cessation of biliary anastomosis drainage has reduced the occurrence of early biliary complications following orthotopic liver transplantation.

Vascular complications after liver transplantation.

Vascular complications following liver transplantation is reviewed based upon literature data and our own results. Our study conclusions are mostly based on literature data, because our center does not have the liver transplantation experience of other centers worldwide. Thus, we may conclude, that the number and character of complications does not differ from those reported by other centers. The enbloc technique used in liver harvesting minimizes the risk of arterial damage in case of vascular anomalies. Recipient retransplantation is the most effective treatment method in cases of hepatic arterial occlusion. Doppler ultrasound examinations are effective to monitor vascular blood flow in the transplanted liver.

Plasmacytic hyperplasia--the early form of posttransplant lymphoproliferative disorder--with atypical morphology and clinical course in patient after liver transplantation: a case report.

This case report describes an early lesion of posttransplant lymphoproliferative disorder (PLTD)--plasmacytic hyperplasia with atypical morphology. The 54-year-old patient was 4 months after liver transplantation due to alcoholic cirrhosis. The postoperative course had been uneventful without graft rejection episodes. Primary immunosuppressive therapy included tacrolimus and prednisone. On admission to the hospital the patient showed rapidly increasing jaundice, hepatomegaly, anemia, thrombocytopenia, and significant leukocytosis. A biopsy suggested generalized infection. Acute Epstein-Barr virus (EBV) infection was confirmed using serological methods. Despite treatment the patient died. On autopsy we found features of generalized infection. Histological examination of the enlarged lymph nodes showed plasmacytic hyperplasia despite lymph node atrophy. Plasmacytic hyperplasia, an early lesion of PTLD despite usually a good prognosis with multifactor therapy may display a rapid course that leads to death through intensified immunosuppression. In accordance with other reports we confirmed reactivation of EBV infection as the probable cause of plasmacytic hyperplasia. The lymph node morphology of plasmacytic hyperplasia may be atypical with atrophy of lymphoid components accompanying plasma cell proliferation.

[Selected parameters of antioxidant capacity in renal allograft recipients]. / Wybrane wskazniki systemu przeciwutleniajacego u biorców allogennej nerki.

UNLABELLED: Various oxidant species, oxygen free radicals (OFR) implicated in patients with chronic renal diseases treated with dialysis and after cadaveric renal transplantation. Oxidative stress occurs when free radical generation exceeds antioxidant defence. We therefore examined markers of lipid peroxidation and antioxidant potential in blood (serum, plasma, RBC) of very carefully (clinically and biochemically) selected 102 subjects (56 female and 46 male, mean age 37.5 +/- 7 years). Included were 51 renal allograft recipients (RARs); 15 patients with glomerulopathies (GL); 36 healthy age- and sex-matched volunteers as a control group (C). All RARs were divided into two subgroups: RARs-A (n = 28) were treated with triple drug therapy including cyclosporin A (CsA) and RARs-Z (n = 23) were on double drug regimen: prednisone, azathioprine. Patients with coronary artery disease (CAD), diabetes, serum creatinine concentration > 2.0 mg/dl, acute rejection and infections were excluded. We used several automated assays to estimate: malondialdehyde (MDA); total radical-trapping antioxidant potential (TRAP), glutathione peroxidase (GPx), glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), vit. E and lipid profiles. Patients of RARs-A were found to have significantly elevated triglycerides; cholesterol-LDL; MDA; TRAP and decreased activity of RBC glutathione peroxidase as compared with those of RARs-Z and group C. IN CONCLUSION: our data show that oxidative stress (with prooxidant effect of CsA partly at least), with reduced in antioxidant potential of defences system is associated with kidney transplantation.

Liver transplantation in the experience of the centre commencing the program.

From 1989 to 1999, 43 orthotopic liver transplantations (OLT) in 40 patients (3 retransplantations) were performed in our Department. The most common indications for OLT were noninflammatory, primary cholestatic liver diseases and postinflammatory liver cirrhosis. Fourty OLT's were done for elective indications, three--on emergency basis, because of fulminant liver failure. The majority of transplantations was performed with classical technique with the excision of retrohepatic vena cava and routine use of the extracorporeal veno-venous bypass. Only in 4 patients the piggyback technique was used and performed without temporary portocaval anastomosis. All 3 patients transplanted for fulminant liver failure died in the perioperative period. Twenty four patients are still alive and well, the longest period of observation exceeding 5 years.

The aging rat kidney displays low glomerular and tubular proteinase activities.

The present study was conducted to investigate the relationship of age-related changes in renal function and structure with changes in glomerular and tubular proteinase activities in young (3 weeks), mature (3 months), and older (18 months) male Wistar rats. Glomerular filtration rate, expressed per 100 g body weight, remained unchanged during adolescence, but declined significantly (-44%) in aging animals. In parallel, albuminuria, which was barely detectable in young and mature rats, increased almost 10-fold in the aging animals. In comparison to young animals, the kidney weight in aging rats was 10-fold higher, signifying considerable tubular hypertrophy. The glomerular protein to DNA ratio increased by almost 70%, suggesting deposition of mesangial matrix within the glomerulus. These structural changes were associated with significant reductions in glomerular cysteine and metalloproteinase activities in the adolescent and older animals. Similarly, lower activities of both types of proteinases were observed in isolated proximal tubules. This behavior of proteolytic enzyme activities in the aging rat kidney corresponds well to the 10-fold increase in kidney weight (proximal tubular hypertrophy) and to the enhanced deposition of glomerular matrix. This study suggests a causal involvement of renal cysteine proteinases and metalloproteinases in the protein accumulation of the aging rat kidney.

Interleukin 2 receptor positive T lymphocytes in renal allograft recipients: association with CMV infection.

The number of interleukin 2 receptor positive T cells freshly isolated from peripheral blood as well as stimulated in culture with PHA was determined in renal allograft recipients with stable graft function, rejection and CMV infection. The most typical phenotype was observed during CMV infection. Patients with CMV had very low levels of circulating positive cells which responded normally to mitogen stimulation in vitro.

Nitrogranulogen enhances IL-1 production but decreases cellular sensitivity to this cytokine.

An alkylating agent, nitrogranulogen, enhances the in vitro production of interleukin 1 by human monocytes. On the other hand, the drug inhibits proliferative responses of mouse thymocytes to exogenously added IL-1. Our results may shed light on the mechanisms of anti-inflammatory action of immunosuppressive agents.

Immune monitoring after renal transplantation. I. HLA-D expression on T cells from renal allograft recipients.

The expression of class II antigens (HLA-DR, DP and DQ) on resting and PHA-activated T cells from renal allograft recipients was studied. A tendency for increase in DR+/DQ+ T cells was noted in azathioprine and cyclosporine-treated recipients undergoing rejection. Low inducible HLA-D expression (especially DP) was associated with CMV infection. Cyclosporine (but not azathioprine) lowered the rate of synthesis of HLA-D by T cells activated in vitro.