Wyniki wyszukiwania - Biblioteka Nauki

1

Post-transplant Metabolic Syndrome (PTMS) after Liver Transplantation – Review of the Literature

100%

Kotarska K. , Raszeja-Wyszomirska J.

Central European Journal of Sport Sciences and Medicine

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2015

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tom 11

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nr 3

29-37

EN

Liver transplant provides a definitive therapeutic measure for patients with chronic and acute liver diseases. Apart from the improvement of overall health, an organ transplant entails several metabolic complications. They are multi-agent and depend, among others, on the function of organ being transplanted, adverse effects of immunosuppression being applied, organ complications induced by failure of the organ being transplanted, current treatment, concomitant diseases and consequences of the acute and chronic rejection processes. Improvements in surgical techniques, peritransplant intensive care, and immunosuppressive regimens have resulted in significant improvements in short-term survival. Focus has now shifted to address long-term outcomes of liver transplantation. Therefore, this paper presents the current review of literature referring to specificity of the prevalence of metabolic syndrome and its complications in patients after liver transplantation.

2

Our experience of liver Epithelioid Hemangioendothelioma: from a misdiagnosis to liver transplantation with long term follow-up

80%

Giuliani A. , Amato B. , Marsilia G. M. , Tafuri D. , Ceriello A. , Santaniello W. , Sodano L. , Rocca A.

Open Medicine

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2014

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tom 10

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nr 1

EN

Malignant Hepatic Epithelioid hemangioendothelioma (HEHE) is an uncommon vascular tumor of intermediate malignant potential. HEHE is a rare tumor and it is difficult to diagnose for surgeons, hepatologists, radiologists and pathologists. So, misdiagnosis with a delay of the treatment is not uncommon. We describe a case of a young woman with a diagnosis of HEHE made 6 years after the first evidence of liver mass with a very long term follow-up after surgical treatment. She had two diagnoses of Hepatocellurar carcinoma (HCC) and a diagnosis of Cholangiocarcinoma after three different fine needle biopsies. After clinical observation, a new laparoscopic core biopsy was performed. In a first time approach, considering clinical and radiological patterns, a diagnosis of Budd-Chiari Syndrome was finally made. For that the patient underwent an orthotopicliver transplantation (OLTx). The surgical sample histological analysis allowed a definitive diagnosis of HEHE. At last, at follow up 7 years after three OLTx the patient is still alive and in good health with no evidence of recurrence.

3

Lifestyle risk factors of non-communicable diseases among patients after liver transplantation – a pilot study

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Jagielska A. , Jankowski K. , Okręglicka K. , Skupin P. , Kozłowska A. , Durlik M. , Pruszczyk P. , Nitsch - Osuch A. , Tronina O.

Family Medicine & Primary Care Review

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2017

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nr 3

214-220

4

Introduction of Liver Transplant Programme in Upper Silesia

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Król R. , Jaworska K. , Karkoszka H. , Chudek J. , Ziaja J. , Badura J. , Pawlicki J. , Oczkowicz G. , Caban A. , Marcinkowski W. , Sekta S. , Wilk J. , Gabriel A. , Gonciarz Z. , Kunsdorf-Wnuk A. , Kokot F. , Więcek A. , Cierpka L.

Polish Journal of Surgery

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2007

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tom 79

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nr 10

656-662

EN

Liver transplantation is the only method of treatment of patients with end stage liver insufficiency. Inadequate number of transplantations in Poland in relation to demands causes a need of new liver transplantation centres formation.The aim of the study was to present process of introduction of liver transplantation programme and results of the first 12 transplantations.Material and methods. Preparations to transplantation were based on training of surgical, anaesthetics and nephrological teams in transplant centres in Paris, Birmingham and Warsaw. Own protocols of organ harvesting, recipients' qualification, transplantation and postoperative treatment were worked out; they were a result of experience acquired in teaching centres. From October 16, 2005 to October 2006, 12 liver transplantations were performed in patients with end stage liver insufficiency of different origin. Patients' age varied from 21 to 67 years. The stage of liver failure according to Child-Pough was 8.6±2.8, and MELD 18.6±7.2. All elective operations were performed using Piggyback technique. Immunosuppression regimen was uniform and consisted of tacrolimus and prednisolone.Results. One patient died due to post reperfusion syndrome with no respond to catecholamine treatment. In 1 patient developed primary lack of the liver graft function that required re-transplantation, which was successfully performed on 2nd postoperative day. Among 10 patients who were discharged from the hospital on mean 31 postoperative day all are alive, and 7 of them returned to full live activity.Conclusion. Training in famous liver transplant centres and own experience in kidney and pancreas transplantation allowed for successful introduction of liver transplantation programme.

5

Human leukocyte antigen associations in Finnish liver transplantations due to primary sclerosing cholangitis and primary biliary cirrhosis

80%

Matinlauri I. , Nurminen M. , Höckerstedt K. , Isoniemi H.

Open Medicine

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2007

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tom 2

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nr 1

12-25

EN

A genetic predisposition has been suggested in primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC). The aim of the study was to evaluate human leukocyte antigen (HLA) frequencies and HLA associations in Finnish PSC and PBC patients. The relative frequencies of HLA-A,-B, and-DR antigens were compared between patients with PSC (n=50), or PBC (n=89), transplanted due to end-stage liver disease, and healthy members in the Finnish bone marrow donor registry (n=10000). Prevalence differences, prevalence ratios and the associated large-sample significance probabilities (2-sided P-values) and 95% confidence intervals were calculated. We found a strong positive association between PSC and HLA-B8 and-DR3, and a weak positive association between HLA-A1 and PSC. HLA-DR3 also had a weak positive association with PBC, and a weak negative association between HLA-DR5 and PBC was found. In conclusion, HLA-B8, and-DR3 are susceptible for progressive liver disease in PSC, and HLA-DR3 may also be susceptible for disease progression in PBC. HLA-DR5 may be protective against severe PBC.

6

Liver transplantation in the treatment of patients with hepatocelular carcinoma

80%

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

Polish Journal of Surgery

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2010

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tom 82

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nr 11

596-602

EN

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.

7

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

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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

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2012

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tom 84

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nr 6

304-312

EN

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.

8

Liver Transplantation in Infants with Body Mass Less than 6 KG

80%

Ismail H. , Broniszczak D. , Apanasiewicz A. , Kasprzyk W. , Teisserye J. , Bacewicz L. , Teisserye M. , Markiewicz-Kijewska M. , Szymczak M. , Jezierska E. , Kaliciński P.

Polish Journal of Surgery

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2009

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tom 81

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nr 2

75-80

EN

Liver transplantation (LTx) is the only treatment of fulminant liver failure and end stage liver disease (ESLD).The aim of the study was to assess indications, status at transplantation, surgical techniques, early and late complications and outcome of liver transplantation in children less than 6 kilograms of body weight.Material and methods. Between 1990 and 2008 in the Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, there were performed 350 LTx. Within them there were 13 (3.7%) newborn and infants with body weight below 6 kilogram. Retrospective analysis was carried out regarding indications for LTx, status at LTx, surgical techniques, early and late follow-up and outcome.Results. Follow-up of 11 living patients ranges from 5 to 111 months (mean 31.5 months). Patients and graft survival is 84.5%. In all patients liver function is very good or good. Advancement in liver surgery and perioperative care caused that LTx in small recipients became possible and are carried out with good outcome.Conclusion. Encouraging results of liver transplantation in newborn and infants caused that lower age and weight limits for liver recipients are no more significant.

9

Prognostic value of perioperative assessment of plasma cardiac troponin I in patients undergoing liver transplantation

80%

Jankowski K. , Trzebicki J. , Bielecki M. , Łągiewska B. , Kurnicka K. , Koczaj-Bremer M. , Pacholczyk M. , Pruszczyk P.

Acta Biochimica Polonica

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2017

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tom 64

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nr 2

331-337

EN

Abstract. An elevation in plasma cardiac troponins is an indicator of increased perioperative risk in orthopaedic and vascular surgery, however, data on liver transplantation (LTx) are scarce. The aim of the study was to evaluate the prevalence of cardiac troponin I (cTnI) elevation in the perioperative period of LTx, and its potential relationship with 1-year mortality. Material and methods. Analysis included 79 patients with liver cirrhosis. During LTx all patients underwent hemodynamic measurements. cTnI level was determined before the operation, 24, 48 and 72 hours afterwards. One-year mortality was assessed. Results. 12.7% patients died, all during in-hospital period. cTnI level on day 1. was identified as the most promising marker of increased death risk with optimal cut-off value of 0.215 ng/mL (the sensitivity of 60.0%, specificity of 87.0%, positive predictive value of 40.0%, negative predictive value of 93.8%). The most important predictor of cTnI increase was the duration of the LTx procedure followed by amount of packed red blood cells transfused, basic stroke volume index, and cardiac output index. In conclusion: value of cTnI level assessed 24 hours post-surgery was a reliable predictor of death following LTx with optimal cut-off value of 0.215 ng/mL. The surgery time was the most important predictor of cTnI elevation.

10

Reoperations for intraabdominal bleeding following deceased donor liver transplantatio

70%

Figiel W. , Grąt M. , Wronka K. , Patkowski W. , Krasnodębski M. , Masior Ł. , Stypułkowski J. , Grąt K. , Krawczyk M.

Polish Journal of Surgery

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2016

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tom 88(4)

196-201

EN

Intraabdominal hemorrhage remains one of the most frequent surgical complications after liver transplantation. The aim of the study was to evaluate risk factors for intraabdominal bleeding requiring reoperation and to assess the relevance of the reoperations with respect to short- and long-term outcomes following liver transplantation. Material and methods. Data of 603 liver transplantations performed in the Department of General, Transplant and Liver Surgery in the period between January 2011 and September 2014 were analyzed retrospectively. Study end-points comprised: reoperation due to bleeding and death during the first 90 postoperative days and between 90 postoperative day and third post-transplant year. Results. Reoperations for intraabdominal bleeding were performed after 45 out of 603 (7.5%) transplantations. Low pre-transplant hemoglobin was the only independent predictor of reoperation (p=0.002) with the cut-off of 11.3 g/dl. Postoperative 90-day mortality was significantly higher in patients undergoing reoperation as compared to the remaining patients (15.6% vs 5.6%, p=0.008). Post-transplant survival from 90 days to 3 years was non-significantly lower in patients after reoperation for bleeding (83.3%) as compared to the remaining patients (92.2%, p=0.096). Nevertheless, multivariable analyses did not reveal any significant negative impact of reoperations for bleeding on short-term mortality (p=0.589) and 3-year survival (p=0.079). Conclusions. Surgical interventions due to postoperative intraabdominal hemorrhage do not appear to affect short- and long-term outcomes following liver transplantation. Preoperative hemoglobin concentration over 11.3 g/dl is associated with decreased risk of this complication, yet the clinical relevance of this phenomenon is doubtful.

11

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

60%

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

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2015

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tom 87

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nr 5

221-230

EN

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.

12

REPRINTED WITH PERMISSION OF EDITOR-IN-CHIEF OF ANNALS OF SURGERY: Annals of Surgery: Vol. 266, nr 5, November 2017; 703 - 705: Modern Surgeons: Still Masters of Their Trade or Just Operators of Medical Equipment?

60%

Krawczyk M.

Polish Journal of Surgery

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2018

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tom 90(2)

1-4

EN

My surgical education began at a time when Poland formed part of the communist bloc and was isolated from the world, or in today’s Terms – it remained behind the Iron Curtain. This was true of all areas of life, including medicine. When after 40 years of work, I look back at my professional career; I wonder whether I owe my proficiency in surgery to my experience and dexterity or, like many others, to technological progress. Two of the great Polish surgeons were my mentors and teachers. Professor Zdzisław Łapiński was the one I met first. He was a manual genius and an unusual operational strategist. Granted, he had one character defect, but nobody’s perfect after all. In 1975, I defended my dissertation. I was convinced that I should continue my education at a center abroad, preferably within a postdoctoral scholarship. Professor Łapiński wanted me to learn everything about surgery from him. I decided otherwise, and in 1978 with his tacit agreement, I obtained a Humboldt Fellowship and went to Heidelberg, to the department headed by none other than Professor Fritz Linder.1 I started my research for the habilitation thesis at the Experimentelle Chirurgie Abteilung of his Department.

13

Short and Long-Term Outcomes After Primary Liver Transplantation in Elderly Patients

60%

Grąt M. , Kornasiewicz O. , Grąt K. , Antczak A. , Ligocka J. , Hołówko W. , Wronka K. M. , Kobryń K. , Skalski M. , Pączek L. , Krawczyk M.

Polish Journal of Surgery

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2013

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tom 85

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nr 10

581-588

EN

The number of elderly patients undergoing liver transplantation (LT) is increasing worldwide. The aim of the study was to evaluate the impact of recipient age exceeding 60 years on early and long-term outcomes after LT. Material and methods. This study comprised data of 786 patients after primary LT performed at a single center between January 2005 and October 2012. Patients over and under 60 years of age were compared with respect to baseline characteristics and outcomes: postoperative mortality (90-day) and 5-year patient (PS) and graft (GS) survival. Associations between recipient age exceeding 60 years and LT results were assessed in multiple Cox regression models. Results. Recipients older than 60 years (n=107; 13.6%) were characterized by more frequent hepatitis C virus infections (p<0.001), malignancies (p<0.001), and cardiovascular comorbidities (p<0.001); less frequent primary sclerosing cholangitis (p=0.002) and Roux-en-Y hepaticojejunostomy (p<0.001); lower Model for End-stage Liver Disease (MELD; p=0.043); and increased donor age (p=0.012). Fiveyear PS of older and younger recipients was 72.7% and 80.6% (p=0.538), while the corresponding rates of GS were 70.3% and 77.5% (p=0.548), respectively. Recipient age exceeding 60 years was not significantly associated with postoperative mortality (p=0.215), PS (p=0.525) and GS (p=0.572) in multivariate analyses. The list of independent predictors comprised MELD (p<0.001) for postoperative mortality; malignancies (p=0.003) and MELD (p<0.001) for PS; and malignancies (p=0.003), MELD (p<0.001) and donor age (p=0.017) for GS. Conclusions. Despite major differences between elderly and young patients, chronological age exceeding 60 years alone should not be considered as a contraindication for LT.

14

Standardy badań ultrasonograficznych Polskiego Towarzystwa Ultrasonograficznego. Ocena układu wrotnego i naczyń wątroby

51%

Lechowicz R. , Elwertowski M.

Journal of Ultrasonography

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2015

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tom 15

|

nr 61

208-226

EN

Increased incidence of liver diseases, the development of liver surgery and other invasive methods for managing portal hypertension, plus an increasing number of liver transplant procedures pose more and more new challenges for ultrasonography. Ultrasonography, being an effective and clinically verified modality, has been used for several decades for diagnosing diseases of the liver, its vessels and portal hypertension. It is used for both initial and specialist diagnosis (performed in reference centers). The diagnostic value of ultrasonography largely depends on the knowledge of anatomy, physiology, pathophysiology and clinical aspects as well as on the mastering of the scanning technique. In the hands of an experienced physician, it is an accurate and highly effective diagnostic tool; it is of little use otherwise. The paper presents elements of anatomy, physiology and pathophysiology which make the portal system exceptional and the knowledge of which is crucial and indispensable for a correct examination and, above all, for the correct interpretation of results. The authors also present requirements regarding the equipment. Moreover, various technical aspects of the examination are presented and the normal morphological picture and hemodynamic parameters of healthy individuals are described. The authors discuss the most common clinical situations and rare cases during ultrasound examinations. The paper is based on the experience of the author who works in the largest center of liver diseases in Poland, and on the current literature.

PL

Wzrost zachorowań na choroby wątroby oraz rozwój chirurgii wątroby i innych inwazyjnych metod leczenia nadciśnienia wrotnego, a także zwiększająca się liczba zabiegów transplantacji wątroby wyznaczają wciąż nowe wyzwania dla ultrasonografii. Ultrasonografia, jako skuteczna i sprawdzona klinicznie metoda, stosowana jest od kilku dekad w diagnostyce chorób wątroby, jej naczyń i nadciśnienia wrotnego. Wykorzystywana jest zarówno na poziomie diagnostyki wstępnej, jak i specjalistycznej – wykonywanej w ośrodkach referencyjnych. Wartość diagnostyczna ultrasonografii w dużym stopniu zależy od znajomości anatomii, fizjologii, patofizjologii i aspektów klinicznych, a także stopnia opanowania techniki badania. W rękach doświadczonego lekarza metoda ta jest precyzyjnym i bardzo skutecznym narzędziem diagnostycznym, w przeciwnym razie jest bezużyteczna. W opracowaniu omówiono podstawowe elementy anatomii, fizjologii i patofizjologii, które stanowią o wyjątkowości układu wrotnego, a których znajomość jest kluczowa i niezbędna dla prawidłowego wykonania badania, a przede wszystkim właściwej interpretacji wyników. Przedstawiono wymagania dotyczące zaawansowania wykorzystywanej aparatury. Omówiono różne techniczne aspekty badania oraz prawidłowy obraz morfologiczny i parametry hemodynamiczne u osób zdrowych, a także najczęstsze sytuacje kliniczne i związane z nimi odchylenia od norm w wykonywanych badaniach. Prezentowana praca oparta jest na kilkunastoletnim doświadczeniu autora pracującego w największym ośrodku chirurgii wątroby w Polsce oraz na podstawie aktualnego piśmiennictwa.

15

Aktywność zawodowa pacjentów po przeszczepie nerki lub wątroby

51%

Czarkowska-Pączek B. , Wesołowska-Górniak K. , Wójtowicz M.

Niepełnosprawność - zagadnienia, problemy, rozwiązania

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2018

|

nr 3(28)

7-24

PL

Przeszczepianie narządów jest obecnie metodą z wyboru leczenia schyłkowej niewydolności narządów, w tym nerek i wątroby. Populacja pacjentów po przeszczepieniu jest duża i nadal się zwiększa. Wynika to zarówno ze wzrostu liczby wykonywanych transplantacji, jak również z wydłużenia okresu przeżycia po transplantacji. Dlatego współcześnie celem kompleksowego leczenia za pomocą przeszczepiania jest nie tylko wydłużenie okresu przeżycia pacjenta, ale także rehabilitacja skutkująca maksymalną psychospołeczną reintegracją i powrotem do aktywnego, w tym zawodowego, życia. Wśród korzyści wynikających z podjęcia pracy po transplantacji wymienia się polepszenie sytuacji materialnej, jakości życia, zmniejszenie depresji, a nawet wydłużenie czasu przeżycia pacjenta i samego przeszczepionego narządu. Wśród pacjentów po przeszczepieniu nerki zatrudnionych jest od 18% do 82%. Średnie zatrudnienie po przeszczepianiu wątroby wynosi 37%, a zakres waha się od 22% do 55%. Różnice w wynikach badań dotyczących zatrudnienia są efektem m.in. braku standaryzacji definicji zatrudnienia, liczebności grupy badanej, kraju, w którym przeprowadzono badanie, a także czasu, który upłynął od przeszczepienia. Znaczenie ma również rok, w którym przeprowadzono badania z uwagi na rozwój transplantologii. Czynniki predysponujące do podjęcia pracy są podobne w grupie pacjentów po przeszczepieniu nerek lub wątroby. Wśród nich na pierwszym miejscu wymienia się zatrudnienie przed przeszczepieniem, młody wiek, płeć męską i poziom wykształcenia. Znaczenie ma także okres niesprawności przed przeszczepieniem oraz etiologia choroby, która doprowadziła do niewydolności narządu. Najczęstszą przyczyną niepodjęcia pracy po przeszczepieniu są problemy ze zdrowiem oraz obawa przed utratą świadczeń z tytułu orzeczenia o niepełnosprawności.

EN

Nowadays, organ transplantation has become the treatment of choice in end-stage organ failure, including renal and liver failure. The population of patients after organ transplantation is steadily growing due to the increase in the number of transplantations and prolonged posttransplant survival. Therefore, the main aim of the complex treatment of organ failure is not only to achieve long-term survival, but also to maximize the quality of life and return to full productivity. Working after organ transplantation contributes to better socioeconomic situation, better quality of life and lower depression rate. It has been also shown to contribute to graft and recipient survival. The rate of employment among renal transplant recipients vary form 18% to 82%. Mean employment rate among liver transplant recipients is 37%, range from 22% to 55%. The discrepancies in the results of various studies results from the lack of standardized employment definition, the various number of study participants, differences in social legislation between countries, and length of post-transplant period. Due to the continuous progress in transplantation, the year of investigation is also important. The main predictors of post-transplant employment are similar among renal and liver recipients and include pre-transplant employment, young age, male gender, higher educational level, and additionally, the etiology of organ failure and the disability period before transplantation. Several factors may be associated with unemployment. In most cases it is poor health and a fear of losing early retirement.

16

Gas exchange abnormalities in patients listed for liver transplantation

51%

Przybylowski T. , Krenke R. , Fangrat A. , Nasilowski J. , Grabczak E. M. , Styczynski G. , Pruszczyk P. , Krawczyk M. , Chazan R.

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tom 57

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nr 4

313-323

EN

Abnormalities of pulmonary gas exchange are common in patients with advanced liver disease. Since arterial blood hypoxemia is an important issue in the preoperative evaluation of liver transplant candidates, the study was undertaken to determine the incidence and severity of lung function impairment with a special emphasis on pulmonary gas exchange abnormalities in this group of patients. 104 consecutive patients (47 F and 57 M, mean age 46 ±11 yr) listed for orthotopic liver transplantation participated in this prospective study. All patients underwent evaluation including: clinical assessment (Child-Pough and MELD classification), chest X-ray, chest sonography, lung function tests, arterial blood gases measurement, and transthoracic contrast enhanced echocardiography. There were 2 patients with acute hepatic failure, 6 patients with primary or metastatic liver carcinoma, and 96 patients with chronic liver disease. The mean PaO2 and lung function parameters for the entire group were within normal limits. There were 29 hypoxemic patients (PaO2< 80 mmHg) and 40 patients with widened (>20 mmHg) P(A-a)O2. DLCO was significantly lower in cirrhotic vs. non-cirrhotic patients (76.5 ±19.3 vs. 92.4 ±19.0% predicted; P<0.001). Hepatopulmonary syndrome (HPS) was recognized in 23 (24%) patients. 91% of patients with HPS showed mild to moderate stage of disease. There were significant difference between differences HPS patients and non-HPS patients in DLCO (69.0 ±14.5 vs. 83.5 ±20.7, P<0.01). In conclusion, all patients referred for OLT should be screened for gas exchange abnormalities. Such a workup should include not only PAO2 but also DLCO and P(A-a)O2 measurement together with contrast enhanced echocardiography.

17

Opieka pielęgniarska nad pacjentem z niewydolnością wątroby przeszczepionej, niezakwalifikowanym do retransplantacji - studium przypadku w oparciu o klasyfikację ICNP®

41%

Ostrowska A. , Sak-Dankosky N. , Czarkowska-Piątek B.

Innowacje w Pielęgniarstwie i Naukach o Zdrowiu

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2019

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tom 4

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nr 4

78-114

EN

Introduction. Life of patient suffering from an advanced-stage liver failure can be saved only by transplantation surgery. Many patients, however, do not qualify for this type of treatment for a variety of reasons. Caring for a patient who was disqualified from the surgery is challenging and requires focusing on all biopsychosocial aspects of patient’s life. Aim of the study. The aims of this study were to identify nursing problems, to estimate the self-care deficits, and to plan nursing care for a patient with a liver transplant failure currently hospitalized in a transplantology unit. Case study. Nursing care of patient with a liver graft failure in the course of chronic graft rejection was carefully planned. The patient was also diagnosed with a chronic kidney disease of unknown aetiology. Moreover, the patient suffered from a fluctuating consciousness and mood depression, manifest aggressive behaviours and the fear of death. To plan patient’s care the International Classification for Nursing Practice ICNP® was used. Discussion. Nursing care was planned in accordance with Virginia Henderson’s theory which emphasizes the Maslow hierarchy of needs Patient required help with daily activities and needed psychological support, especially in coping with his current situation and dealing with the feeling of loneliness. Conclusions. Applying the International Classification for Nursing Practice ICNP® in the planning of nursing care for a patient with liver graft failure enables the improvement of the patient's quality of life and the awareness of nursing care in the international area.

PL

Wstęp. Życie pacjenta z niewydolnością wątroby w zaawansowanym stadium można uratować jedynie dzięki transplantacji. Istnieje jednak wiele przyczyn, z powodu których pacjenci mogą zostać do niej niezakwalifikowani. Opieka nad pacjentem, niezakwalifikowanym do transplantacji, wymaga szczególnego zaangażowania pielęgniarki we wszystkie biopsychospołeczne sfery życia pacjenta. Cel pracy. Celem pracy była identyfikacja problemów pielęgnacyjnych, określenie deficytu samoopieki oraz zaplanowanie opieki pielęgniarskiej nad pacjentem z niewydolnością wątroby przeszczepionej, niezakwalifikowanego do retransplantacji, przebywającego w szpitalu na oddziale transplantologii. Opis przypadku. Zaplanowano opiekę nad chorym z niewydolnością wątroby przeszczepionej w przebiegu przewlekłego odrzucania, chorującym także na przewlekłą chorobą nerek o niejasnej etiologii, u którego występują również zaburzenia świadomości, agresja, obniżony nastrój i strach przed śmiercią. W planowaniu opieki zastosowano Międzynarodową Klasyfikację Praktyki Pielęgniarskiej ICNP®. Dyskusja. Plan opieki został opracowany według teorii Virginii Henderson. Pacjent wymagał pomocy w czynnościach dnia codziennego oraz wsparcia psychicznego, szczególnie pomocy w zrozumieniu jego obecnej sytuacji i radzeniu sobie z uczuciem samotności. Wnioski. Zastosowanie Międzynarodowej Klasyfikacji Praktyki Pielęgniarskiej ICNP® w planowaniu opieki pielęgniarskiej nad pacjentem z niewydolnością wątroby przeszczepionej pozwala na polepszenie jakości opieki na pacjentem i umożliwiona analizę wiedzy o opiece nad pacjentem w kontekście międzynarodowym.

18

Arginase isoenzymes in human cirrhotic liver

41%

Chrzanowska A. , Gajewska B. , Baranczyk-Kuzma A.

Acta Biochimica Polonica

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2009

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tom 56

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nr 3

465-469

EN

Cirrhosis leads to an inability of the liver to perform its biochemical functions. It can also lead to hepatocellular carcinoma in which, as we showed lately, arginase isoenzyme pattern changes. The present work presents our results on arginase isoenzymes and their possible role in liver cirrhosis. The study was performed on tissues obtained during liver transplantation from 60 patients with liver cirrhosis, and on samples of histologically normal liver (control) from 40 patients with benign or colorectal cancer liver metastases removed during surgery, 6-7 cm from the tumor border. Arginase isoenzymes AI (so-called liver-type arginase) and AII (called extrahepatic arginase) were identified by Western blotting and isolated by ion-exchange chromatography. Their expression on mRNA level was studied by RT-PCR. A significant decrease in arginase activity, dependent of the liver clinical stage, was observed in cirrhotic tissue. Arginase AI activity and its mRNA level were significantly decreased in cirrhotic liver, whereas the activity and expression of arginase AII were concurrently raised, as compared to normal liver. Since arginase AI is a key enzyme of the urea cycle, whereas arginase AII most probably takes part in the biosynthesis of ornithine and polyamines, the defective ammonia inactivation and increased collagen biosynthesis observed in cirrhotic liver may be related to the changes in arginase AI and AII levels, respectively.

19

Pathogenesis and clinical consequences of iron overload in chronic hepatitis C - impact of host and viral factors related to iron metabolism

41%

Sikorska K. , Romanowski T. , Bielawski K. P.

BioTechnologia. Journal of Biotechnology Computational Biology and Bionanotechnology

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2011

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tom 92

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nr 1