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4 Polish Journal of Surgery

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Bile Duct Cysts

100%

Krawczyk M. , Arkuszewski P. , Zieniewicz K. , Grąt M.

Polish Journal of Surgery

2010

tom 82

nr 10

564-572

Aim of the study was analysis of methods of surgical treatment of patients with bile duct cysts.Material and methods. Retrospective analysis of data from 30 patients who underwent surgical treatment for bile duct cysts in Clinic of General, Transplantation and Liver Surgery, Warsaw Medical University, between 1 October 2001 and 31 December 2009.Results. Bile duct cysts are more common in females; female to male ration is 4:1. Most of the treated patients had bile duct cysts belonging to type I according to Todani classification - 13 patients (43.3%). Six patients (20%) had type IV cysts, 8 patients (26.7%) had type V cysts according to Todani classification. Three patients (10%) with isolated intrahepatic bile duct cysts were not classified to any group according to Todani classification. The most common type of surgical treatment was complete resection of intrahepatic bile duct with choledocho-intestinal Roux-en-Y anastomosis that was performed in 17 patients (56.7%). The other patients generally underwent various types of resections of the liver and bile ducts or only of the liver. Five patients (16.7%) required liver transplantation. Nine patients (30%) developed complications. One patient (3.3%) who underwent liver transplantation and retransplantation, died from progressive multiorgan failure and renal failure.Conclusions. First line treatment of patients with bile duct cysts involves their resection, sometimes with requirement of resection of liver parenchyma. Most of these patients underwent reconstruction of bile duct through choledocho-intestinal Roux-en-Y anastomosis. Some patients undergo liver transplantation. Surgical treatment of patients with bile duct cysts is demanding from the technical point of view and should be undertaken in centers that specialize in hepatobiliary surgery.

Liver transplantation in the treatment of patients with hepatocelular carcinoma

63%

Krawczyk M. , Grąt M. , Kornasiewicz O. , Zieniewicz K. , Nyckowski P. , Patkowski W. , Grzelak I. , Dudek K. , Wróblewski T. , Paluszkiewicz R.

Polish Journal of Surgery

2010

tom 82

nr 11

596-602

The aim of the study was to analyse liver transplantation results in patients with hepatocellular carcinoma, considering selected factors.Material and methods. The study group comprised 82 patients subject to liver transplantation at the Department of General, Transplant and Liver Surgery, Warsaw Medical University, due to hepatocellular carcinoma. Retrospective analysis concerned the period between 2001 and 2010. Distant survival results were evaluated, depending on whether Milan criteria were fulfilled, and the preoperative level of alpha-fetoprotein estimated. The obtained results were subject to statistical analysis. p<0.05 was considered as statistically significant.Results. Mean survival time considering patients subject to liver transplantation, due to hepatocellular carcinoma amounted to 66.7 months (95% PU 58.9-74.4), while survival without tumor recurrence - 62.3 months (95% PU 54-70.6). The one, three and five - year survival rate was 88.7%, 74.8% and 72.0%, respectively. Survival without tumor recurrence was 87.5%, 67.1% and 67.1%, respectively. The overall survival of patients fulfilling the Milan criteria (44 of 82 patients - 53.7%) was significantly longer, in comparison to patients not fulfilling the above-mentioned (74.4 and 48.3 months, respectively, p=0.025). A significant difference was also observed, considering the overall survival in the absence of cancer recurrence (72.5 and 42.4 months, respectively, p=0.007). Considering patients not fulfilling the Milan criteria who presented with preoperative alpha-fetoprotein levels > 100 ng/ml, overall survival was shorter, as compared to the mean survival rate: 32.5 and 64.4 months, respectively, p = 0.009. Similar values were obtained in case of patients without tumor recurrence (27 and 57.1 months, p=0.011).Conclusions. The obtained results confirmed the significant value of Milan criteria, when qualifying patients with hepatocellular carcinoma for liver transplantation. The above-mentioned also showed the potential value of preoperative alpha-fetoprotein level measurements, not only in the diagnostics and early hepatocellular carcinoma diagnosis (patients with cirrhosis), but also in the prediction of survival and tumor recurrence after liver transplantation.

Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw

26%

Krawczyk M. , Grąt M. , Grąt K. , Wronka K. , Krasnodębski M. , Stypułkowski J. , Masior Ł. , Hołówko W. , Ligocka J. , Nyckowski P. , Wróblewski T. , Paluszkiewicz R. , Patkowski W. , Zieniewicz K. , Pączek L. , Milkiewicz P. , Ołdakowska-Jedynak U. , Najnigier B. , Dudek K. , Remiszewski P. , Grzelak I. , Kornasiewicz O. , Kotulski M. , Smoter P. , Grodzicki M. , Korba M. , Kalinowski P. , Skalski M. , Zając K. , Stankiewicz R. , Przybysz M. , Cieślak B. , Nazarewski Ł. , Nowosad M. , Kobryń K. , Wasilewicz M. , Raszeja-Wyszomirska J. , Piwowarska J. , Giercuszkiewicz D. , Sańko-Resmer J. , Rejowski S. , Szydłowska-Jakimiuk M. , Górnicka B. , Wróblewska-Ziarkiewicz B. , Mazurkiewicz M. , Niewiński G. , Pawlak J. , Pacho R.

Polish Journal of Surgery

2015

tom 87

nr 5

221-230

Liver transplantation is a well-established treatment of patients with end-stage liver disease and selected liver tumors. Remarkable progress has been made over the last years concerning nearly all of its aspects. The aim of this study was to evaluate the evolution of long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw). Material and methods. Data of 1500 liver transplantations performed between 1989 and 2014 were retrospectively analyzed. Transplantations were divided into 3 groups: group 1 including first 500 operations, group 2 including subsequent 500, and group 3 comprising the most recent 500. Five year overall and graft survival were set as outcome measures. Results. Increased number of transplantations performed at the site was associated with increased age of the recipients (p<0.001) and donors (p<0.001), increased rate of male recipients (p<0.001), and increased rate of piggyback operations (p<0.001), and decreased MELD (p<0.001), as well as decreased blood (p=0.006) and plasma (p<0.001) transfusions. Overall survival was 71.6% at 5 years in group 1, 74.5% at 5 years in group 2, and 85% at 2.9 years in group 3 (p=0.008). Improvement of overall survival was particularly observed for primary transplantations (p=0.004). Increased graft survival rates did not reach the level of significance (p=0.136). Conclusions. Long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery are comparable to those achieved in the largest transplant centers worldwide and are continuously improving despite increasing recipient age and wider utilization of organs procured from older donors.

1000 Liver Transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw - Analysis of Indications and Results

23%

Krawczyk M. , Grąt M. , Barski K. , Ligocka J. , Antczak A. , Kornasiewicz O. , Skalski M. , Patkowski W. , Nyckowski P. , Zieniewicz K. , Grzelak I. , Pawlak J. , Alsharabi A. , Wróblewski T. , Paluszkiewicz R. , Najnigier B. , Dudek K. , Remiszewski P. , Smoter P. , Grodzicki M. , Korba M. , Kotulski M. , Cieślak B. , Kalinowski P. , Gierej P. , Frączek M. , Rdzanek Ł. , Stankiewicz R. , Kobryń K. , Nazarewski Ł. , Leonowicz D. , Urban-Lechowicz M. , Skwarek A. , Giercuszkiewicz D. , Paczkowska A. , Piwowarska J. , Gelo R. , Andruszkiewicz P. , Brudkowska A. , Andrzejewska R. , Niewiński G. , Kilińska B. , Zarzycka A. , Nowak R. , Kosiński C. , Korta T. , Ołdakowska-Jedynak U. , Sańko-Resmer J. , Foroncewicz B. , Ziółkowski J. , Mucha K. , Senatorski G. , Pączek L. , Habior A. , Lechowicz R. , Polański S. , Leowska E. , Pacho R. , Andrzejewska M. , Rowiński O. , Kozieł S. , Żurakowski J. , Ziarkiewicz-Wróblewska B. , Górnicka B. , Hevelke P. , Michałowicz B. , Karwowski A. , Szczerbań J.

Polish Journal of Surgery

2012

tom 84

nr 6

304-312

The aim of the study was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw.Material and methods. Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival.Results. The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations.Conclusions. Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.