Thoracic epidural analgesia in anaesthesia for liver transplantation: the 10-year experience of a single centre.

BACKGROUND: Improvements in operating techniques, methods of anaesthesia and postoperative care in liver transplantation (LT) contribute to better outcomes. In order to restrict postoperative mechanical ventilation, a thoracic epidural analgesia (TEA) has been performed in our centre since 2000. In this report we present our 10-year experience of using TEA as a component of LT anaesthesia. MATERIAL/METHODS: TEA was performed, by anaesthetists experienced in this method, on patients qualified for LT, who consented and met inclusion criteria: INR<1.5, APTT<45s and platelets >70 G/L. Since 2008 the decision to insert an epidural catheter has been additionally supported by thromboelastometry. We assessed extubation time, frequency of complications of TEA and undesired accidents. RESULTS: From 279 patients undergoing LT, TEA was performed on 67 (24%), and from these 56 (84%) were extubated in the operating theatre. There were 5 cases of unsatisfactory thoracic epidural analgesia. Only 1 epidural catheter was removed accidentally, on the 2nd postoperative day. None of the complications of TEA were observed in the TEA group. CONCLUSIONS: Based on our observations, it can be assumed that TEA done by experienced an anaesthetist is a safe component of anaesthesia in selected groups of patients undergoing LT, and allows for early extubation.

Bacterial infections in the early period after liver transplantation: etiological agents and their susceptibility.

BACKGROUND: The study comprises an analysis of bacterial infections in the early period after liver transplantation (LT) in adults. MATERIAL/METHODS: Eighty-three patients were followed for four weeks after LT. Samples comprised mainly blood, urine, surgical-site specimens, sputum, and stool. Culture and identification of the isolated microorganisms was done in accordance with standard microbiological procedures. Susceptibility testing was carried out using CLSI guidelines. Statistical analysis was done with Medi-Stat. RESULTS: In total, 913 samples from LT recipients were cultured. Of the 469 isolated strains, 331 (70.6%) were Gram-positive bacteria, 133 (28.4%) were Gram-negative bacteria, and 5 (1.0%) were yeast-like fungal strains. Of the 284 surgical-site isolates, 222 (78%) were Gram-positive and 61 (21.5%) were Gram-negative bacteria. Of the 99 blood culture isolates, 75 (75.8%) were Gram-positive and 22 (22.2%) of Gram-negative bacterial strains. Of the 73 urine samples, 46 (63.0%) were strains of Gram-negative, 25 (34.0%) of Gram-positive bacteria, and 2 (3.0%) fungal strains. In the 13 respiratory tract samples were 9 (69.0%) Gram-positive and 4 (31.0%) Gram-negative strains. In the 54 stool samples, 63.0% and 16.7% were C. difficile toxin- and culture-positive, respectively. In total, 138 strains of MRCNS, 10 of MRSA, 80 of HLAR, and 19 ESBL(+) were detected. CONCLUSIONS: The isolation of MDR bacterial strains such as MRSA (52.6%), MRCNS (81.7%), HLAR (86.0%), and ESBL(+) Gram-negative rods (12.5%) from patients after LT indicates the need for strict adherence to infection control procedures.

Assessment of cadaveric livers discarded from transplantation. A correlation between clinical and histological parameters.

BACKGROUND: We designed a study with the following aims: to assess tissue quality of 100 cadaveric livers discarded from transplantation, to identify discarded organs which could have been used either for transplantation or for isolation of hepatocytes, to assess donor clinical factors which may impact the histology. MATERIAL/METHODS: Liver wedge biopsies were performed during kidney procurement, sent for processing and data interpretation. RESULTS: In 46% of the evaluated tissues severe changes were found; these organs according to pathologists were "not suitable for transplantation". In 19% less pronounced changes classified organs as "probably not suitable for transplantation". In 35% biopsies only minimal changes were found; these organs were classified as "probably suitable for transplantation" and could have been harvested as marginal organs or at least used for hepatocytes isolation. CONCLUSIONS: Results of biopsies suggested that approximately in one third of livers discarded from transplantation due to clinical donor parameters could have been harvested from histological point of view. Several donor clinical risk factors (alcohol addiction, hyperbilirubinemia, increased transaminase activity) correlate with severe histological changes rending the liver "not suitable for transplantation".

[Hepatocellular carcinoma--epidemiology and treatment]. / Rak watrobowokomórkowy-- epidemiologia i leczenie.

Hepatocellular carcinoma (HCC) is one of the most commonly occurring solid tumors worldwide and is the most frequent cause of cancer death in some parts of the world such as China and sub-Saharan Africa. HCC appears to be rising dramatically in incidence in developed western countries too. The most frequent underlying factors causing HCC are chronic viral hepatitis and cirrhosis. Early detection of HCC is a key factor in improving outcomes of therapies. There is growing evidence that HCC may be prevented with strategies aimed at preventing or treating viral hepatitis. Surgery, including liver transplantation, remains the most efficient treatment but only for 15-30% of patients. Recent developments suggest that other therapeutic modalities such as loco-regional (ablative) methods are also potentially curative.

[Current status of liver transplantation]. / Stan przeszczepiania watroby w Polsce.

The authors present current status of liver transplantation (LTx) in Poland. Till 2004, 845 LTx were performed: 604 in adults and 241 in children; 71 of them were the living donor LTx. Post-inflammatory cirrhosis in adults and biliary atresia in children were the most common indications for LTx. The results of LTx in Poland are good and comparable with the results published by other centers. The number of available cadaveric grafts is growing and in 2004 achieved an index of harvesting as high as 14,7 per million people.

[Technical progress in liver transplantation]. / Postep w technikach przeszczepiania watroby.

Throughout the history of liver transplantation many improvements have been made in the field of surgical technique. The technical progress improved results of liver transplantation; the split liver transplantation and living donor liver transplantation increased the number of cadaveric grafts, expanding primary the pediatric and later the adult liver graft pool. The authors present most of current methods of liver transplantation: orthotopic liver transplantation with or without preservation, of the inferior vena cava, "domino" liver transplantation, split liver transplantation, auxiliary liver transplantation and living donor liver transplantation.