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Hickson, L. J., Cosio, F. G., El-Zoghby, Z. M. és mtsai: Survival of patients on the kidney transplant wait list: relationship to cardiac troponin T. Am. J. Transplant., 2008, 8 , 2352–2359. El-Zoghby Z. M

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Interventional Medicine and Applied Science
Authors: E. Hartmann, A. Németh, Gy. Juharosi, Zs. Lénárd, P. Á. Deák, V. Kozma, P. Nagy, Zs. Gerlei, I. Fehérvári, B. Nemes, D. Görög, J. Fazakas, L. Kóbori, and A. Doros

Carcinoma: A Simulative Analysis of Dropout From the Waiting List for Liver Transplantation Liver Transplantation 11 508 514 . 19

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A szerző áttekinti a hepatocellularis carcinoma májátültetéssel történő gyógyításának eredményeit. A restrikciós kritériumok alkalmazásával elért eredmények mára már meghaladják a sebészi reszekciók eredményeit több központban. Fontos: a daganat biológiai tulajdonságait jellemző marker, a des-karboxi-protrombin használatával ázsiai központok jelentősen módosították a jelenlegi kritériumrendszert. Áttekinti a szerző a várólistán lévő betegek kezelésének lehetőségeit, valamint a jelenleg elvégezhető technikákat, amelyekkel a betegek alkalmassá válhatnak transzplantációra.

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Orvosi Hetilap
Authors: Zoltán Szabolcs, István Hartyánszky, Tivadar Hüttl, Levente Fazekas, Orsolya Balogh, Dávid Becker, Pál Soós, Tamás Varga, Erzsébet Paulovich, Endre Németh, Kristóf Rácz, Ferenc Horkay, and Béla Merkely

Az 1992. január 3-ával elindult hazai felnőttszív-átültetési program számos fejlődési stádiumon ment át az elmúlt 20 évben. A kezdetben szinte társadalmi munkában beindult tevékenység működési kerete lassan vált szervezetté. Az elmúlt két évtized állandó velejárója volt az alacsony donációs aktivitás és a várólistás betegek alacsony száma, mindez azt eredményezte, hogy a lassan emelkedő műtéti számok ellenére a transzplantációs aktivitás folyamatosan elmaradt a kívánalmaktól. Az Eurotransplanthoz történő részleges csatlakozásunk azonban új kihívást jelentett a hazai felnőttszív-átültetési program számára. Ezen új kihívásoknak és elvárásoknak történő megfelelési szándék azonban kikényszerítette a teljes felnőttszív-átültetési program átszervezését, új alapokra helyezését. A Semmelweis Egyetem Ér- és Szívgyógyászati Klinikáján 2011 ősze és 2012 tavasza közötti fél évben számos olyan strukturális, szemléletmódbeli, képzési változtatást valósítottak meg, amelyek hatására a klinika transzplantációs kapacitása megsokszorozódott, a transzplantációs tevékenység biztonsága sokat javult. Az alapjaiban megújított program eredményeként 2012-ben 131%-kal nőtt a klinikán elvégzett műtétek száma az előző évihez viszonyítva. A 86,63%-os 30 napos túlélési rátájával pedig a húszéves program legeredményesebb évét zárta. Orv. Hetil., 2013, 154, 863–867.

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Orvosi Hetilap
Authors: Bernadett Borda, Edit Szederkényi, Aurél Ottlakán, Éva Kemény, Viktor Szabó, Zoltán Hódi, and György Lázár

Satayathum, S., Pisoni, R. L., McCullough, K. P., et al.: Kidney transplantation and wait-listing rates from the international Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int., 2005

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and long-term survival compared with dialyzed patients. Due to the gradual increase in the number of patients on the transplant waiting list, expanding the criteria regarding donors is required. Although most studies of expanded criteria donor (ECD

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Satayathum, S., Pisoni, R. L., McCullough, K. P., et al.: Kidney transplantation and wait-listing rates from the international Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int., 2005, 68 , 330

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Interventional Medicine and Applied Science
Authors: Attila Doros, Pál Ákos Deák, Erika Hartmann, Andrea Németh, Zsuzsa Gerlei, János Fazakas, Dénes Görög, Balázs Nemes, Imre Fehérvári, and László Kóbori

Abstract

Introduction: Biliary strictures remain a key problem after liver transplantation. Anastomotic strictures are treated by surgery or interventional therapy. Intrahepatic stenosis requires retransplantation. For bridging, percutaneous and endoscopic interventions are used. The extent of the strictures may have an important role in therapy planning. Methods: Strictures were divided into four zones (1: extrahepatic, not included in this study; 2: hilar; 3: central; 4: peripheral). Twenty patients were treated with balloon dilatation/stent implantation/retransplantation/supportive care (Zone 1: 0/0/0/0; Zone 2: 8/7/2/0; Zone 3: 7/5/2/1; Zone 4: 1/1/3/1). Results: Mean follow-up time was 48 months. In Zone 2, one patient died as a result of recurrent hepatocellular carcinoma (HCC), and seven patients are alive, five after stent placements and two after retransplantation. Four patients are alive in Zone 3: all had stent placements and one later retransplantation. One patient died after retransplantation, two on the waiting list, and one due to chronic liver failure. One patient is alive in Zone 4 after early retransplantation, and three died. Conclusion: Percutaneous therapy is safe and effective in intrahepatic biliary stenosis after liver transplantation. It can provide the cure or bridge retransplantation. Based on zonal classification, we recommend the following treatments: Zone 4: early retransplantation; Zone 2: minimally invasive therapy; Zone 3: individual decisions.

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The prevalence of hepatitis C virus infection among patients on hemodialysis is about ten times higher than in the normal population. The infection can induce chronic glomerulonephritis, as an extrahepatic manifestation, which can lead to end-stage renal disease. However, in the majority of patients hepatitis C virus is acquired as a nosocomial infection during hemodialysis. Most of the infected patients have usually normal liver enzymes and need regular screening for hepatitis C antibody to detect the infection. Despite the normal liver enzymes, the liver disease may progress to cirrhosis. Some of the patients are on the renal transplantation waiting list. The immunosuppressive treatment after renal transplantation results in a significantly increased viral replication which might induce further progression of the liver disease. Interferon treatment given after transplantation can induce rejection and graft failure. Therefore the antiviral treatment should be administered during or before the hemodialysis period. Only limited data are available about the treatment of patients with impaired renal function. Alfa-interferon was used mostly in these patients. Due to its impaired renal clearance and higher serum concentration interferon seems to be more effective, but less tolerable in patients with end-stage renal disease than in other groups of patients. Ribavirin is also excreted exclusively by the kidney with anemia being even more pronounced in these patients, and as such is contraindicated in patients on hemodialysis. The pharmacokinetics of the pegylated interferon alfa-2a is very advantageous for patients with end-stage renal disease. The safety and efficacy of peginterferon alfa-2a is now being confirmed in many publications.

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Despite intensive therapy, the mortality of acute hepatic failure is 60 to 90% without liver transplantation. Due to the limited number of transplantable organs, however, a significant percentage of patients die while on the waiting list. In order to reduce mortality, several attempts have been made to remove the albumin-bound and water-soluble toxic substances accumulated in hepatic failure, aimed at supporting spontaneous regeneration of the liver and maintaining patients alive until liver transplantation. Prometheus® treatment is a relatively new technique combining Fractionated Plasma Separation and Adsorption (FPSA) with high-flux dialysis. During the procedure the patient’s own separated albumin-rich plasma flows through special adsorbers, allowing elimination of toxins bound to albumin, while the water-soluble toxins are removed by haemodialysis. Objective: The authors’ intention was to demonstrate the efficacy of Prometheus® treatment in patients with acute hepatic failure due to intoxication. Patients and Method: Prometheus® treatment was administered in three patients with acute hepatic failure due to severe intoxication caused by paracetamol, potassium permanganate and Amanita phalloides , respectively, that could not be controlled by conservative therapy. Results: Ten treatments were performed in the three female patients. No serious complication was observed. Significant reduction of albumin-bound toxins (unconjugated bilirubin p = 0.048; bile acid p = 0.001) and water-soluble toxins (conjugated bilirubin p = 0.002; creatinine p = 0.007) was observed. Ammonia, urea, fibrinogen and antithrombin III levels showed no significant change. All three patients recovered without liver transplantation. Conclusion: Toxins accumulated in acute hepatic failure can be removed efficiently by Prometheus® treatment. The procedure is safe. In cases not controllable by conservative therapy it allows patients survive until their liver regenerates spontaneously or liver transplantation becomes feasible.

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