Authors:Balázs Nemes, D. Görög, I. Fehérvári, T. Mándli, E. Sárváry, L. Kóbori, A. Doros, and J. Fazakas
Portal vein reconstruction might be a challenge in certain cases of liver transplantation. The problem usually arises due to small vessels in pediatric transplantation and/or living related donor and split liver transplantation, or as a result of extensive PVT in adult recipients. Authors report a case of a 60-year-old alcoholic cirrhotic patient with reverse portal flow. The standard end to end portal anastomosis did not work well, so a mesoportal shunt with a donor iliac vein conduit was performed first, followed by a cavoportal hemitransposition. After unsuccessful attempts of providing good portal flow, the donor umbilical vein and the iliac conduit was used for portal flow reconstruction as meso-Rex graft. The patient has been doing fine for eight months after her liver transplantation. Unusual types of portal reconstructions consist of meso-portal, umbilico-portal, renoportal anastomoses that are primarily used as rescue techniques. However, it is rare that one has to use them sequentially in the same patient.
Authors:Szilágyi Miklós, L. Szilágyi, L. Görög, C. Luca, D. Cozma, G. Ivanica, and Z. Benyó
This paper presents an analysis of the Arruda accessory pathway localization method for patients suffering from Wolff-Parkinson-White syndrome, with modifications to increase the overall accuracy. The Arruda method was tested on a total of 79 cases, and 91.1% localization performance was reached. After a deeper analysis of each decision point of the Arruda localization method, we considered that the lead aVF was not as relevant as other leads (I, II, III, V1) used. The branch of the decision tree, which evaluates the left ventricle positions, was entirely replaced using different decision criteria based on the same biological parameters. The modified algorithm significantly improves the localization accuracy in the left ventricle, reaching 94.9%. An accurate localization performance of non-invasive methods is relevant because it can enlighten the necessary invasive interventions, and it also reduces the discomfort caused to the patient.
Authors:A. Doros, B. Nemes, Z. Máthé, A. Németh, E. Hartmann, Á. P. Deák, Zs. F. Lénárd, D. Görög, I. Fehérvári, Zs. Gerlei, J. Fazakas, Sz. Tóth, and L. Kóbori
Hepatic artery complication represents recognized sequel of liver transplantation that carries significant morbidity and mortality. Besides retransplantation, hepatic artery recanalization is provided surgically, or by percutaneous angioplasty and stent placement. This study provides an analysis of a single center experience comparing surgical and interventional treatments in cases of early hepatic artery complications.
In this retrospective single center study, 25 of 365 liver transplant recipients were enrolled who developed early hepatic artery complication after transplantation. Percutaneous intervention was performed in 10 cases, while surgical therapy in 15 cases. Mean follow-up time was not different between the groups (505±377 vs. 706±940 days, respectively).
6 patients in the Intervention Group and 10 patients in the Surgery Group are alive. The retransplantation rate (1 and 3) was lower after interventional procedures, while the development of biliary complications was higher. The mortality rate was higher after operative treatment (2 and 5).
Interventional therapy is a feasible and safe technique for treatment of early hepatic artery complication after transplantation. Being less invasive it is an invaluable alternative treatment having results comparable to surgical methods.
Authors:Enikő Sárváry, Zs. Gerlei, E. Dinya, E. Tóth, M. Varga, R. Chmel, M. Molnar, A. Remport, B. Nemes, L. Kobori, D. Görög, J. Fazakas, I. Gaal, J. Járay, F. Perner, and R. Langer
Patients on hemodialysis (HD) and renal transplant recipients (RT) have a high prevalence of HCV infection. The aim of our study was to determine the prevalence of HCV-RNA in the anti-HCV positive patients and to compare the biochemical parameters of PCR(+) and PCR(−) subgroups. Methods: The 525 sera were screened for anti-HCV. HCV-RNA was detected by polymerase chain reaction (PCR) and liver enzymes [SGOT, SGPT, GGT, α-glutathione S-transferase (GST)] were measured. Results: Active viraemia was found only in 187 of 289 (65%) seropositive HD patients in contrast to 53 of 53 (100%) of seropositive RT patients. Significantly increased (p<0.05) GST values (9.9 μg/l) were found in the PCR(+) subgroups compared to GST levels (2.7 μg/l) of the PCR(−) subgroups. Elevated GST concentration was found in 80% (208/251) of PCR(+) patients. The measured enzymes were not elevated in HCV infected patients. Six percent of HD and 11% of RT patients were screened before seroconversion. Diagnostic sensitivity (80%) and specificity (79%) of GST were calculated as good for early liver damage caused by HCV. In contrast, the sensitivity of the measurement of other liver enzymes were very weak (SGOT: 8%; SGPT: 10%; GGT: 42%). Conclusion: The significantly higher viraemia of the RT subgroup could be related to the immunosuppressive therapy. Increased GST level may be a useful indicator of tissue damage during HCV infection. If HCV infection is suspected, PCR and GST measurement should be performed, even if anti-HCV result is negative.
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
Hepatocellular carcinoma, which has developed in liver cirrhosis is a disease where liver transplantation can provide a cure both for the tumour and the underlying liver damage. However, patients can only be transplanted when the tumour number and size do not exceed the Milan criteria. Tumour ablation methods — such as radiofrequency ablation — can provide a chance to make the patient eligible for transplantation. Among the 416 Hungarian liver transplanted patients there are 6 who had received different types of ablative therapy as bridging therapy in different institutions. On the basis of analysis of the patients' data we created a guideline for the treatment of cirrhotic patients with hepatocellular carcinoma with the aim of developing a uniform Hungarian approach.