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20 May 2003 : Case report  

Liver transplantations in adult recipients – experience of one center

M. Pacholczyk, B. Łągiewska, A. Chmura, J. Trzebicki, L. Adadyński, L. Jureczko, G. Szyszko, U.. Ołdakowska, M. Kołacz, T. Cieciura, W. Rowiński

Med Sci Monit 2003; 9(2): 31-34 :: ID: 15307


Material/Methods: Between July 2000 and March 2003,48 cadaveric liver transplantation were performed in our department. There were various indications for the treatment.The most common indication was viral hepatitis (27%). Other common indication were:ALD (16.6%),cryptogenic cirrhosis (10.4%),PBC (10.4%),AIH (10.4%),acute liver failure due to Wilson ’s disease (8.3%),PSC (6.2%).HCC was diagnosed in 3 patients with HCV cirrhosis (6.2%). In 46 patients primary liver transplantation was performed. In 2 cases late graft failure (1st liver transplanted else- where)was the indication. Urgent transplantation was required in 9 (18.7%)patients. The whole organ was transplant- ed in all but one case (reduced graft). In 45 patients piggy-back technique was used (93.7%).The use of veno-venous by-pass (biopump)was necessary only in one case.Donor iliac by-pass graft was used to reconstitute arterial blood inflow to the graft in 4 cases (infrarenal –2,supratruncal –1,recipient ’s splenic artery –1).Recipient portal vein thrombectomy was performed during transplantation in 2 cases.In all the cases,the graft was rinsed with the recipient ’s blood in the volume of 300 ml before reperfusion.In all cases except one,biliary anastomosis was per- formed by the end-to-end technique with Levin catheter drainage.All the patients received transcutaneous enteral nutrition in the postoperative period.Standard immunosuppressive regimen consisted of: Prograf and steroids. Results:42 patients (87.5%)were discharged home with a well-functioning liver graft.Mean hospitalization time was 36 days.6 patient died in early postoperative period (septicemia –2,CVA –1,Vanco-resistant Cl.difficile –1,cardiac failure –1,irreversible hepatic coma –1).Further 2 patients died 4 and 13 months after transplantation,respectively (home acquired fungal septicemia,metastatic HCC).Survival rate after urgent transplantations was 55.5%and 94.8% after elective procedure.Actual one year graft and patient survival rate is 84.6%.Four patients required early re-oper- ation;3 for bleeding (G.I.–1,spleen rupture –1,diaphragm oozing –1)and one for biloma.Recurrent active HCV hepatitis requiring INF+Ribavirin treatment was observed in 3 recipients.Acute graft rejection was treated with pulses of Methylprednisolone in 7 recipients (14.5%)

Keywords: Liver Transplantation, complications after liver transplantation, acute liver failure

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750