Impact of the venting via vena cava inferior on the outcome of liver transplantation

BACKGROUND

The liver transplantation is a standard treatment method for the indicated group of patients with a final hepatic failure. The aim of this paper was to compare two reperfusion methods of implanted liver, non-venting and venting vena cava, and to evaluate the impact of both techniques on the post reperfusion syndrome.

METHODS

We compared two groups of patients: non-venting (n = 42) and venting (n = 41). We monitored bilirubin, liver enzymes and hemodynamic changes after reperfusion. We recorded monitored parameters immediately prior to the transplantation, during and after the reperfusion and on the 1st postoperative day. All liver grafts were used from the donors after a brain death.

RESULTS

We did not find a statistically significant difference in input monitored parameters. We detected significant changes of pH after reperfusion in both monitored groups. We determined a significantly better saturation in the non-venting group, bigger consumption of fresh frozen plasma and thrombo-concentrate in the non-venting group, a significantly higher value of total bilirubin and a lower value of Quick's time in the non-venting group.

CONCLUSION

Venting via vena cava inferior did not impact the perioperative and early postoperative course of liver transplantation in our group of patients. However, further analyses are required (Tab. 2, Fig. 3, Ref. 20).

[First Czech and Slovak domino liver transplantation]

INTRODUCTION

The study introduces the first international, Czech and Slovak Domino Transplantation performed based on a tight cooperation between the Czech and Slovak transplant centres.

MATERIAL AND METHODS

The donor of the cadaveric graft was a young Slovak man with Familial amyloidotic polyneuropathy. The livers of these patients are the predominant source of circulating transthyretin, and liver transplantation is the only treatment available for the disease. The graft was obtained from heart beating deceased donor with brain death. The domino graft was then transplanted to Czech sixty-three years old man with hepatocellular carcinoma and liver cirrhosis based on HCV.

RESULTS

Both recipients had an uneventful immediate postoperative course with early graft function. The Czech patient faced early HCV recurrence in a graft which necessitated the reduction of immunosuppressives.

CONCLUSION

The domino liver transplantation represents a suitable way for addressing graft shortage and reducing waiting list time. A well-organized cooperation between the two international centres is required to complete successful domino transplantation.

A prospective comparison of bladder versus enteric drainage in vascularized pancreas transplantation

In previous years, the number of pancreas transplants has increased significantly. Debate continues over the optimum technique for exocrine drainage. Enteric drainage (ED) has recently been increasingly popular owing to the long-term complications of bladder drainage (BD). We prospectively evaluated 40 consecutive pancreas transplant recipients undergoing either bladder (n = 20) or enteric (n = 20) drainage. After simultaneous kidney-pancreas transplantation 1-year patient, kidney, and pancreas graft survival rates were 95%, 95%, 85% for the BD group, and 90%, 85%, 85%, for the ED group. Surgical complications were not significantly different between the two groups. The incidence of acute rejection, major infections and cytomegalovirus disease were also similar. The length of the initial hospital stay was likewise comparable. However, the BD group was characterized by a slight increase in the number of urologic complications, metabolic acidosis, and dehydration. Our results suggest excellent patient and graft survival irrespective of the drainage technique.

A prospective comparison of bladder versus enteric drainage in vascularized pancreas transplantation

Although the number of pancreas transplants has increased significantly in previous years, debate continues concerning the optimum technique for exocrine pancreas drainage. Enteric drainage (ED) has recently been increasingly popular due to the long-term complications with bladder drainage (BD). We prospectively assigned 40 consecutive pancreas transplant recipients to either bladder (n = 20) or enteric (n = 20) drainage. Patient, kidney, and pancreas graft survival rates at 1 year after simultaneous kidney-pancreas transplantation were 95%, 95%, 85%, for BD group and 90%, 85%, 85% for ED group, respectively. Surgical complications were not significantly different between the two groups. The incidence of acute rejection, major infections, and CMV disease were similar between groups. The length of the initial hospital stay was likewise comparable. However, the BD group showed a slight increase in the number of urologic complications, metabolic acidosis, and dehydration. Based on the results of our study, patient and graft survivals were excellent irrespective of technique.

[Vascular complications after pancreatic transplantation]

Transplantation of pancreas is presently the only way of treating diabetes of the 1st type, capable to secure a long-term normoglycemia. In spite of the fact that the surgical technique and tactics of the whole intervention has been standardized over the last years, surgical complications and more specifically vascular complications still pose a certain risk of the graft loss. The thrombosis of vessels of the transplanted pancreas occurred in our group in 4.1 per cent of cases. The other rare complications included a false aneurysm of the supplying artery and stenosis of the out-coming vein from the pancreatic graft. Both these complications were successfully treated by a radio-invasive approach. A refinement of the surgical technique and the introduction of new immunosuppressive drugs manifests favorably in decreasing occurrence of vascular complications after the transplantation of pancreas.

[Surgical treatment of renal carcinoma and thrombosis of the inferior vena cava]

INTRODUCTION

In Slovakia every year some 600 renal carcinomas are diagnosed. This number includes 5 to 10% carcinomas with a tumours thrombus is the renal vein or inferior vena cava. The objective of the present work is to describe diagnostic and surgical methods is patients with this disease.

MATERIAL AND METHODS

The authors describe the surgical procedures, depending on the level of the tumours thrombus in the inferior vena cava in a group of 22 patients operated at the Urological department of the F. D. Roosevelt Hospital in Banská Bystrica in 1997 to 2001.

RESULTS

In all 22 patients the tumours thrombus was removed along with the tumours kidney. In two instances the thrombus reached as far as the right atrium and in 4 patients with a tumours thrombus in a subdiaphragmatic position extracorporeal circulation was used. There was no death in conjunction with the surgical operation. There was one complication caused by haemorrhage which called for surgical revision. Eight patients died during the investigation period as a result of a relapse and generalization of the disease.

CONCLUSION

Based on the authors' experience and data in the literature the authors recommend surgery of the kidney with a tumours thrombus of the inferior vena cava as safe treatment in special hospital departments.