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Összefoglaló. Bevezetés: Veseátültetést követően a graft és a beteg túlélésére hatással lehetnek a posztoperatív intervenciót igénylő szövődmények. Fontos szempont a műtéttechnikai eredményesség monitorozása. Többek között az irodalomban számos lehetőség ismert a veseátültetés sarokpontjának számító ureteranastomosis elkészítésére is, de az éranastomosisok technikája szintén döntő lehet. Célkitűzés és módszer: Retrospektíven vizsgáltuk a 2010 és 2020 között végzett veseátültetéseket a Debreceni Egyetem Sebészeti Klinikáján. Célul tűztük ki a sebészeti szövődmények vizsgálatát, melyeket rendszereztünk, a módosított Clavien-féle beosztás alapján. A legnagyobb figyelmet az ureteranastomosisokra fordítottuk. Minden betegnél az adott kategóriában legsúlyosabb szövődményt vettük alapul a beosztáshoz. A minimális utánkövetési idő 1 év volt. Az adatokat az SPSS statisztikai program segítségével elemeztük. Eredmények: A vizsgált periódusban 406 veseátültetés történt, melyből 24,4% (n = 99) vesetranszplantáltnál alakult ki intervenciós (sebészeti, radiológiai, urológiai) szövődmény. A betegek átlagéletkora 49,5 ± 13,7 év, 60,8% férfi volt. A kumulatív mortalitás 10,1% volt. Grade 4-es szövődmény a betegek 6,9%-ánál (n = 28), Grade 3-as a 6,7%-ánál (n = 27), Grade 2-es a 3%-ánál (n = 12), Grade 1-es a 7,9%-ánál (n = 32) jelentkezett. A veseátültetés után 20,4%-ban (n = 83) alakult ki későn induló graftfunkció. Következtetés: A legenyhébb kategóriába (Grade 1.) került a legtöbb beteg, a szövődmények jelentős része sebészi, intervenciós radiológiai és urológiai közreműködéssel megoldható volt. Az ureteranastomosisok műtéti technikája és a releváns szövődmények kialakulása között nincs szignifikáns összefüggés. Megfelelő és időben alkalmazott korrekciós kezelés mellett a graft- és betegtúlélést nem rontja szignifikánsan az enyhe és középsúlyos (Grade 1–3.) szövődmények kialakulása. Orv Hetil. 2021; 162(26): 1038–1051. Summary. Introduction: Complications associated with postoperative intervention may affect graft and patient survival after kidney transplantation. Monitoring the effectiveness of surgery is an important aspect. Ureter anastomosis can be the pivot of kidney transplant, the same as vascular anastomosis, so efficiency of the surgical technique is important to follow up. Objective and method: We retrospectively examined kidney transplants performed between 2010 and 2020 at the Department of Surgery of the University of Debrecen. Data were analyzed by the SPSS statistical program. We aimed to investigate surgical complications, which were systematized based on the modified Clavien classification. In one patient, the most severe complication was used as the basis for the schedule. The minimum follow-up time was 1 year. Results: 406 kidney transplants were performed in the examined period, of which 24.4% (n = 99) developed renal transplant complications (surgical, radiological, urological). The mean age of the patients was 49.5 ± 13.7 years, and 60.8% were male. The cumulative mortality was 10.1%. Grade 4 complication developed in 6.9% (n = 28) of the recipients, Grade 3 in 6.7% (n = 27), Grade 2 in 3% (n = 12), and Grade 1 in 7.9% (n = 32). 20.4% of the recipients had delayed graft function. Conclusion: The Grade 1 group had the biggest case number, so a significant part of the complications could be solved with the help of interventional radiology and urologists. There is no significant association between the surgical technique of ureteral anastomoses and the development of related complications. With appropriate therapy, graft and patient survival are not significantly impaired by the development of Grade 1–3 complications. Orv Hetil. 2021; 162(26): 1038–1051.

Primary pancreatic hydatid disease is extremely rare. Diagnosis of the disease is difficult because hydatid cysts can be confused with a pseudocyst or neoplastic cystic diseases. Authors report a case of a surgically treated hydatid disease of the uncinate process of pancreas. In a 34-year-old patient with minor symptoms, a cystic disease of the pancreas was accidentally identified. CT scan revealed a multivesicular cystic mass with a maximum of 13-cm diameter and with a calcificated wall. During laparotomy, the uncinate process of pancreas was resecated and the cystic lesion was enucleated. Patient was recovered without complications and recurrence of the disease. There must be a suspicion of hydatid disease when cysts are identified in good conditioned, asymptomatic patients, or in case of wall calcification or multivesicular cysts revealed by radiological images. Surgical procedures are recommended in uncertain diagnoses too, because differentiation preoperatively between cystic pancreatic lesions is often impossible.

Surgical complications (SCs) are still high potential causes of graft loss. The incidence has a huge amount of variations depending on many factors. Our aim was to study the postoperative technical complications following kidney transplantations (KTs) during a 5-year period between 2011 and 2015. In the observed time frame there were 47 SCs occurring in 32 (19.4%) patients of 165 KTs. Every complication was classified into 3 groups: vascular (11; 6.6%), urologic (16; 9.7%), and any others (20; 12.1%). The most common postoperative SCs in our center were hemorrhage (14; 8.5%), urinary leakage (12; 7.2%), and renal artery stenosis (6; 3.6%). Twenty-seven patients, 84% of those having had a SC, needed an intervention, mainly a surgical correction (28; 62%). Half of these interventions (21; 51%) were performed due to urologic reasons. As possible predicting factors, we studied the type of arterial and ureter anastomosis in relation to onset of vascular and urologic complications. There was no significant correlation. The same was true for any donor and/or recipient demographic parameters. However, the presence of SCs impaired both patient and graft survival. The cumulative 6-month, 1-, 3-, and 5-year patient survival rates were 97% versus 99%, 93% versus 99%, 84% versus 97%, and 84% versus 97% for patients with/without (w/wo) a SC, respectively (P = .028). The cumulative 6-month, 1-, 3-, and 5-year graft survival rates were 81% versus 96%, 77% versus 94%, 68% versus 86%, and 54% versus 86% for the same 2 groups, respectively (P = .003).

Background Bacterial infections significantly affect graft loss and mortality after kidney transplantation (KT). We reviewed the frequencies, risk factors, and sources of bacterial infections after KT and their impact on graft and patient survivals. Methods The data of 154 kidney recipients who underwent transplantation from 2010 to 2015 were explored. Donor, recipient, and surgical parameters were collected, and source, type, and frequency of infectious complications, number of infective episodes, multidrug-resistant (MDR) bacteria, and the bacterial spectrum were established. Results The most common infection was urinary tract infection, which is in line with the literature. Out of the 154 recipients, 72.1% ( n = 111) had at least 1 occasion of a bacterial infection episode with clinical symptoms. It occurred 0–43 months (mean, 19.5 mo) after transplantation. Ninety-three KT recipients (67.9%) developed 274 episodes of infection in the postoperative 1st year (1.8 episodes/patient/y), and 42 patients had admission to the hospital ward (5.2 d/patient/y). MDR was detected in 19.8% of the infections. Conclusions A bacterial infection had no significant impact on survival by itself. However, in case of sepsis graft and patient survivals were lower compared with normal control subjects.

Introduction: Indication and timing of allograft nephrectomy is still uncertain in some cases. Aim: The aim of the authors was to summarize their experience with graftectomies. Method: Data from patients who underwent kidney transplantation between January 1, 2004 and December 31, 2015 were retrospectively analyzed. Frequency, indications, timing, complications as well as early and late allograft nephrectomies were reviewed. Results: From 480 renal transplants, 55 graftectomies were performed (11%). Frequent indications included chronic allograft nephropathy (47%), arterial blood supply complications (13%), ureter complications (9%). 22 cases (40%) of allograft nephrectomies were urgent while 33 cases (60%) were elective. 24% of graftectomies were performed within 30 days after transplantation and 76% thereafter. Conclusions: The main indications for early graftectomies were arterial complications (31%) and chronic allograft nephropathy (62%) in cases of late graftectomies. The majority of the graftectomies were elective. Leading indication was chronic allograft nephropathy. Early and late graftectomies have different characteristics. Orv. Hetil., 2016, 157(24), 964–970.

Introduction: To ease organ shortage many transplant centres developed different donor scoring systems, however, a general consensus among clinicians on the use of these systems does not still exist. Aim: The aim of the authors was to analyse the effect of expanded criteria donor, deceased donor score and kidney donor risk index on postoperative kidney function and graft survival. Method: Analysis of the characteristics of 138 kidney transplantations and 205 donors in a retrospective study of a five-year period. Results: There was a trend towards rejecting donors in higher risk groups; 22.7% of standard criteria donors belonged to the high risk group of deceased donor score. Graft function was worse in high risk patients. High risk donors can be divided due to the use of deceased donor score. Patients with the highest risk had worse graft function and survival. Conclusions: With the use of these scoring systems grafts with favourable outcome can be selected more precisely. Orv. Hetil., 2016, 157(24), 946–955.

Women with renal disease, besides many dysfunctions, face increasing infertility and high-risk pregnancy due to uremia and changes of the hormonal functions. After renal transplantation, sexual dysfunction improves, providing the possibility of successful pregnancy for women of childbearing age. However, kidney transplanted patients are high-risk pregnant patients with increased maternal and fetal risks, and the graft also may be compromised during pregnancy; most studies report on several successive deliveries due to multidisciplinary team management. In clinical practice, the graft is rarely affected during the period of gestation. Fetal development disorders are also rare although preterm delivery and intrauterine growth retardation are common. For now, several studies and clinical investigations proved that, under multidisciplinary control, kidney transplanted female patients are also possible to have safe pregnancy and successful delivery. There are conflicting data in the literature about the prevention of complications and the timing of pregnancy. Herein, we would like to present some experience of our centre. A total of 847 kidney transplantations have been performed between June 1993 and December 2013 with 163 childbearing aged females (18–45 years) in our center. We report on three kidney transplanted patients who have given birth to healthy newborns. In our practice, severe complications have not been observed.

Introduction Approximately 10% of renal allografts fail during the first year after kidney transplantation (KT) and 3%–5% thereafter yearly. The indication and timing of allograft nephrectomy (AN) is still uncertain in some cases. The aim of this study was to reveal the ratio, etiology, and complications of AN at our center. Material and Methods This is a retrospective study of all patients who underwent KT at our center between January 1, 2004 and December 31, 2014. We analysed the frequency, indications, timing, and complications of ANs. Also early and late ANs were compared. Results From 417 renal transplantations 49 ANs were performed (11.7%). The most frequent indications were chronic allograft nephropathy (25; 51%), arterial blood supply complications, like arterial thrombosis and stenosis (7; 15%), treatment-resistant acute rejection (3; 6%), and nonreparable ureter complications (3; 6%). The average time of AN since KT was 28 months. ANs were performed as an urgent setting in 16 (33%) cases, whereas it was elective in 33 cases (67%). The AN was executed within 30 days (early) in 11 (22%) cases, and thereafter (late) in 38 (78%) cases. The main indication for early AN was renal artery thrombosis (4; 37%) and chronic allograft nephropathy (25; 66%) for late AN. Surgical complications occurred in 10 cases (20; 4%). The most common was hematoma. Conclusion The majority of the ANs were elective and late (more than 30 days; average time, 47 months). Leading indication was chronic allograft nephrectomy. Early ANs were urgent and life-saving in all cases.

Background and Aim Management of hepatitis C virus (HCV) recurrence is a major challenge after liver transplantation. Significant dysregulated expression of HCV receptors (i.e. claudin-1, occludin, tetraspanin CD81, scavenger receptor type B1) has been shown recently during HCV infection. This might facilitate hepatocytic entry and reinfection of HCV. MicroRNAs (miRs) play role in the regulation of gene expression. We aimed to characterize miR expression profiles related to HCV infection and antiviral therapy in adult liver transplant recipients, with special emphasis on miRs predicted to target HCV receptors. Methods Twenty-eight adult liver transplant recipients were enrolled in the study. Paired biopsies were obtained at the time of HCV recurrence and at the end of antiviral treatment. MiRs for HCV receptors were selected using target prediction software. Expression levels of miR-21, miR-23a miR-34a, miR-96, miR-99a*, miR-122, miR-125b, miR-181a-2*, miR-194, miR-195, miR-217, miR-221, and miR-224 were determined by reverse transcription–quantitative polymerase chain reaction. Results miR-99a* and miR-224 expressions were increased in HCV recurrence samples, while miR-21 and miR-194 were decreased in comparison to normal liver tissue. Increased expressions of miR-221, miR-224, and miR-217 were observed in samples taken after antiviral therapy when compared with HCV recurrence samples. High HCV titer at recurrence was associated with higher level of miR-122. Conclusions Samples at recurrence of HCV and after antiviral therapy revealed distinct HCV-related miR expression profiles, with significant dysregulation of those miRNAs potentially targeting mRNAs of HCV receptors. In particular, miR-194 and miR-21 might be involved in the regulation of HCV receptor proteins' expression during HCV infection and antiviral therapy.

Background Organ transplantation has become an organized, routine, widely used method in the treatment of several end-stage diseases. Kidney transplantation means the best life-quality and longest life expectancy for patients with end-stage renal diseases. Transplantation is the only available long-term medical treatment for patients with end-stage liver, heart, and lung diseases. Despite the number of transplantations increasing worldwide, the needs of the waiting lists remain below expectations. Methods One of the few methods to increase the number of transplantations is public education. In cooperation with the University of Debrecen Institute for Surgery Department of Transplantation, the Hungarian National Blood Transfusion Service Organ Coordination Office, and the Local Committee Debrecen of Hungarian Medical Students' International Relations Committee (HuMSIRC), the Gerundium, a new educational program, has been established to serve this target. Gerundium is a special program designed especially for youth education. Peer education means that age-related medical student volunteers educate their peers during interactive unofficial sessions. Results Volunteers were trained during specially designed training. Medical students were honored by HuMSIRC, depending on their activity on the basis of their own regulations. Uniform slides and brochures to share were designed. Every Hungarian secondary school was informed. The Local Committee Budapest of HuMSIRC also joined the program, which helps to expand our activity throughout Hungary. The aim of the program is public education to help disperse disapproval, if presented. Conclusions As a multiple effect, our program promotes medical students to have better skills in the field of transplantation, presentation, and communication skills. Our program is a voluntary program with strong professional support and is free of charge for the community.

Management of hepatitis C virus recurrence is a challenge after liver transplantation.The aim of the authors was to analyse the outcome of liver transplantation performed in hepatitis C virus positive patients during the past ten years and to compare recent data with a previous report of the authors.The authors retrospectively evaluated the data (donors, recipients, perioperative characteristics, patient and graft survival, serum titer of hepatitis C virus RNA, histology) of 409 patients who underwent liver transplantation between 2003 and 2012.156 patients were transplanted due to hepatitis C virus associated liver cirrhosis (38%). Worse outcome was observed in these patients in comparison to hepatitis C virus negative recipients. The cumulative patient survival rates at 1, 5, and 10 year were 80%, 61%, 51% in the hepatitis C virus positive group and 92%, 85%, 79% in the hepatitis C virus negative group, respectively (p0.001). The cumulative graft survival rates at 1, 5 and 10 year were 79%, 59% and 50% in hepatitis C virus positive and 89%, 80% and 70% in hepatitis C virus negative patients (p0.001). Hepatitis C virus recurrence was observed in the majority of the patients (132 patients, 85%), mainly within the first year (83%). The authors observed recurrence within 6 months in 71 patients (56%), and within 3 months in 26 patients (20%). The mean hepatitis C virus recurrence free survival was 243 days. Higher rate of de novo diabetes was detected in case of early recurrence. The cumulative patient survival rates at 1, 3, 5, 10 years were 98%, 89.5%, 81% and 65% when hepatitis C virus recurrence exceeded 3 months and 64%, 53%, 30.5% and 30.5% in patients with early recurrence (p0.001).Poor outcome of liver transplantation in hepatitis C virus positive patients is still a challenge. Hepatitis C virus recurrence is observed earlier after liver transplantation in comparison with a previous report of the authors. De novo diabetes occurs more frequently in case of early recurrence. Despite an immediate start of antiviral treatment, early recurrence has a significant negative impact on the outcome of transplantation.Bevezetés: A hepatitis C-vírus-fertőzés kiújulása továbbra is kihívás májátültetést követően. Célkitűzés: Az elmúlt tíz évben hepatitis C-vírus-infekcióval transzplantált betegek adatainak elemzése, összevetése korábbi eredményeinkkel. Módszer: A szerzők vizsgálták a donor és recipiens perioperatív adatait, a túlélést, a szövődmények arányát a hepatitis C-vírus-infekcióval összefüggő és egyéb indikációval végzett májátültetések, valamint korai és késői hepatitis C-vírus-infekció kiújulása esetén. Eredmények: 409 beteg közül 156 hepatitis C-vírus-pozitív beteg került májátültetésre (38%). A hepatitis C-vírus-fertőzött betegek túlélése és a grafttúlélés is rosszabb volt, mint egyéb indikációval végzett májátültetések esetén. A betegek 85%-ában a kiújulás igazolható volt, többségüknél egy éven belül. Három hónapon belüli rekurrencia igazolódott 26 betegnél. A májátültetéstől a vírus kiújulásáig átlagosan 243 nap telt el. A betegtúlélés három hónapon belül észlelt kiújulás esetén szignifikánsan rosszabb volt, mint három hónapon túli kiújulás esetén. Következtetések: A szerzők korábbi közléséhez képest az utóbbi tíz évben a víruskiújulást hamarabb észlelték. Korai kiújulás a prognózist lényegesen rontja, a rövid időn belül megkezdett antivirális kezelés ellenére. Orv. Hetil., 2013, 154, 1058–1066.

Introduction: The first renal transplantation was completed in 1991 at the University of Debrecen. In 2013 Hungary joined Eurotransplant. Aim: The authors retrospectively compared the trends. Method: Comparison between Period A (from January 1, 2008 to August 31, 2013) and Period B (from September 1, 2013 to October 22, 2015). Results: The proportion of living transplants rose from 3.5% to 9.1 %. During period B over 25% of utilized donors were over 60 years of age. Recipients with body mass index above 30 kg/m2 increased from 12% to 31%. Prevalence of diabetes among recipients rose twofold. Uretero-neocystostomy was used during period A (99%) while in period B end to side uretero-ureteral anastomosis has also gained popularity (68%). In 2013 the authors introduced routine use of induction treatment. Acute rejection rate decreased from 34% to 8%. The rate of surgical complications did not change. Acute bacterial infections decreased from 41% to 33%. Cumulative renal allograft 1, 3 and 5 year survival rates were 86.6%, 85% and 82.7% in group A vs. projected rates 88%, 84% and 84% in group B, respectively. Conclusions: Despite the growing proportion of expanded criteria donors, the authors were able to maintain a low incidence of delayed graft function and a favorable graft survival. Since 2013 the authors introduced treatments for acute humoral rejection according to international standards. Orv. Hetil., 2016, 157(24), 925–937.

Adult-onset Still's disease is a rare systemic non-infectious inflammatory disease of unknown aetiology. It is characterized by high spiking fever, sore throat, arthralgia, transient maculopapular rash, hepatosplenomegaly, liver cytolysis, weight loss, leukocytosis, neutrophilia, lymphadenopathy, myopathia and polyserositis. Mild or moderate liver involvement is common but fulminate liver failure is a rare manifestation. We report a 41-year-old male with undiagnosed adult Still's disease who underwent liver transplantation due to acute fulminate liver failure. He died 6 months after the liver transplantation in a septic condition. To date, six patients with adult Still's disease-related liver failure have been reported who required liver transplantation. We emphasize that adult Still's disease should be considered in the differential diagnosis of fulminate liver failure, especially in young adults with fever of unknown aetiology or typical features in the history.

Background Availability of suitable donor organs has always limited the number of liver transplantations performed. Use of marginal donor organs is an alternative to overcome organ shortage. Objective To analyze the effect of various combinations of donor organ quality and recipient status on the outcome of liver transplantation. Materials and Methods Data from 260 whole-liver transplantations performed between January 2003 and September 2009 were analyzed retrospectively. Study groups were established according to donor organ quality (marginal score 0–1 vs 2–5) and recipient status (Model for End-Stage Liver Disease [MELD] score 17). In patients at low risk, 102 received optimal grafts (good-to-good group [G/G], and 75 received marginal grafts (bad-to-good group [B/G]. In patients at high risk, 46 received optimal grafts (good-to-bad group [G/B], and 37 received marginal grafts (bad-to-bad group [B/B]. Results No differences were observed in cumulative patient and graft survival rates; however, total survival differed in the early period after transplantation, that is, within 1 year. There was a higher rate of overall postoperative complications including initial poor graft function, bleeding, infection, and kidney failure in group B/B compared with group G/B (25 of 37 patients [67.5%] vs 27 of 46 patients [59.0%]), group B/G (25 of 37 patients [68%] vs 39 of 75 patients [52%], and group G/G (25 of 37 patients [68%] vs 43 of 102 patients [42%]) ( P = .04). Patients with a high MELD score (G/B and B/B) demonstrated increased risk of postoperative complications. Use of donor organs with marginal score of 2 or higher in patients with high MELD scores increased early patient mortality. Conclusion In summary, patients with a high MELD score (G/B and B/B) are at an increased risk of post-OLT complications. In contrast, use of marginal grafts (B/G and B/B) increased the rate of hepatitis C virus recurrence and decreased the response rate to antiviral therapy. The combination of impaired donor grafts and recipients at high risk should be avoided.

Correct assessment and follow-up of kidney function is essential in liver transplant recipients. Glomerular filtration rate (GFR) represents the functional capacity of the kidney. The GFR is generally determined on the basis of creatinine clearance using several methods. It has been suggested that cystatin C be used rather than GFR. Production of cystatin C is not dependent on the same factors as creatinine. It is filtered and completely metabolized in the glomeruli, and is not secreted by the kidney tubules. The objective of this study was to determine a preoperative cutoff value for cystatin C based on kidney function estimated after liver transplantation. At prefixed times before and after orthotopic liver transplantation (OLT), serum cystatin C and creatinine concentrations were measured, and GFR was calculated using the Cockroft-Gault equation. Patients were divided into 2 groups according to GFR on postoperative days 1 to 5. Group 1 (healthy recipients) included patients with post-OLT GFR greater than 70 mL/min; and group 2 (kidney-impaired recipients), post-OLT GFR less than 70 mL/min. Group 2 demonstrated greater risk of postoperative complications, abnormal postoperative creatinine concentrations and GFR values, and worse patient and graft survival. Based on the preoperative cystatin C concentration, postoperative kidney function can be assessed. The cutoff value for preoperative cystatin was determined using receiver operating characteristics analysis. When the preoperative cystatin C concentration exceeded 1.28 mg/L, the postoperative GFR was less than 70 mL/min in the first 5 days after OLT. These findings suggest that if the cystatin C concentration exceeds the cutoff point preoperatively, there will be deterioration of kidney function after OLT. Along with other researchers, we suggest that cystatin C is a sensitive marker of post-OLT kidney function.

A de novo diabetes mellitus a májátültetés gyakori szövődménye.Célkitűzés:A de novo diabetes gyakoriságát, jelentőségét és a kockázati tényezők szerepét vizsgáltuk.Módszer:1995 és 2009 között 310 májátültetett beteg adatait dolgoztuk fel retrospektív módszerrel. De novo diabetest állapítottunk meg, ha az éhomi vércukor a 3. posztoperatív hónapon túl ismételten >6,8 mmol/l volt, és/vagy a májátültetés után tartós, a 3. posztoperatív hónapot meghaladóan is fenntartott antidiabetikus terápia indult.Eredmények:De novo diabetes a betegek 20%-ánál (63 beteg) alakult ki. A de novo és a kontrollcsoport között az alábbiakban találtunk különbséget. Donor-testtömegindex (24±3 vs. 22,4±3,6 kg/m2, p = 0,003), férfi nem (58% vs. 33%, p = 0,002). Recipienséletkor (47,6±7,2 vs. 38,3±14,6 év, p2, pKövetkeztetés:Májátültetést követő de novo diabetes kockázati tényezői az időskor, elhízás, férfi nem és a C-vírus okozta cirrhosis. Víruspozitív betegek körében a korai rekurrencia, súlyosabb viraemia és az antivirális kezelés ellenére kialakuló súlyosabb fibrosis összefügg a de novo diabetes kialakulásával.

A májátültetések számát korlátozza a beültetésre alkalmas donorszervek mennyisége. A szervhiány megoldására az egyik lehetőség az úgynevezett marginális donorok (extended donor criteria) elfogadása a májátültetési programban.Célkitűzés:A magyar májátültetési program szervdonációs jellemzőinek vizsgálata, különös tekintettel a marginális donorokra.Módszer:Donor- és recipiensadatok retrospektív feldolgozása 2003. január és 2008. december között. A marginálisdonor-kritériumrendszert nemzetközi ajánlások alapján állítottuk fel.Eredmények:A vizsgált periódus alatt összesen 1078 donort jelentettek a klinikán. Nyolcszázharmincöt esetben (77,4%) alkalmatlannak ítélték a donormájat a transzplantációra, 243 esetben (22,6%) volt beültetésre alkalmas a donormáj. A beültetett májgraftok közül 40 (16%) származott marginális, 203 (84%) nem marginális donorból. Marginális májgraftok beültetése esetén nem volt különbség a beteg- és grafttúlélésben, a posztoperatív graftfunkciót jelző paraméterekben és az általános szövődmények gyakoriságában. A korai hepatitis C-rekurrencia gyakoribb volt marginális graft beültetése esetén.Következtetések:A májátültetésre váró betegek száma hazánkban is folyamatosan növekszik. Marginális májgraftok alkalmazása esetén a betegek morbiditása és mortalitása nem különbözik számottevően a standard donorokból származó májgraftok beültetése után tapasztalt eredményektől. Hepatitis C-vírus esetén nem javasolt marginális májgraft beültetése. A donorok felső életkori határának kiterjesztése megfontolandó.

Background To ease organ shortage, many transplant centers accept kidneys from expanded-criteria donors (ECDs). Our aim was to analyze the results of ECD grafts in our center. Methods Data on cadaveric donors were retrospectively analyzed between January 2011 and September 2014. Definition of ECD was: (1) donor age ≥60 years, (2) donor age 50 to 59 years, and (3) the presence of 2 among the following criteria: hypertension, serum creatinine >1.5 mg/dL, or death from cerebrovascular accident. Standard-criteria donors (SCDs) were those who did not meet the criteria for an ECD. Results During the observation period, 215 cadaveric donors were reported within our region, and 14 kidneys were offered to our center from Eurotransplant. Ninety-one (40%) among the reported donors were ECDs and 123 (54%) were SCDs. The rates of delayed graft function (DGF) and acute rejection (ARE) were not influenced by transplantation of an ECD graft. The cumulative patient and graft survival rates for ECDs were comparable with those of patients who received an optimal graft. Conclusions ECD grafts can be transplanted safely, without the increased risk of DGF, ARE, and inferior patient and graft survival, in the case of careful patient allocation, and with the use of induction therapy.

Horseshoe kidney is a fusion anomaly found in approximately one in 400–600 people. Due to vascular and ureteral variations, transplantation with a horseshoe kidney presents a technical challenge. In our case, the isthmus connected the upper poles and contained parenchyma. It consisted of three renal arteries, five veins collected to the inferior vena cava, and two ureters and pyelons. It was implanted en bloc to the left side retroperitoneally. During the early period, cellular and humoral rejection was confirmed and treated. For a urine leak, double J catheters were implanted into both ureters. Later, the first catheter was removed. Subsequently, urinary sepsis developed, necessitating graftectomy. The uncommon anatomy of ureters and antibody-mediated rejection (AMR) may both be factors for a ureter tip necrosis led to an infected urinoma. After other Hungarian authors, we also report a horseshoe kidney transplantation that was technically successful. However, after an adequately treated but severe acute humoral rejection, the patient developed sepsis, and the kidney had to be removed. We conclude that transplantation with horseshoe kidney is technically feasible but may increase the risk for urinary complications and resultant infections. Careful consideration of risk and benefit is advised when a transplant professional is faced with this option.

In addition to hepatitis C, hepatocellular carcinoma. is a leading indication for orthotopic liver transplantation (OLT). The indications for OLT in HCC remains a topic of debate. The successful Milan criteria are still accepted as the gold standard to select candidates with a good chance for long-term survival. The Hungarian Liver Transplant Program launched in 1995 reached 45 OLT/year in 2010. Among 412 first OLTs, there were 49 cases of a malignant tumor, including 41 among which the indication was the tumor. Of the 412 patients, 154 (37.4%) were hepatitic C virus (HCV) positive, including 29 with HCC and 23 cases in which HCC was the indication itself. Half of the HCC patients were within the Milan criteria; 50% exceeded the criteria. We observed a solitary HCC in 36% of cases: 2 foci in 18%; 3 in 7%, 4 in 14%, and ≥5 in 25%. Only 12 patients underwent a "down-staging" treatment before OLT: 8 radiofrequency ablation (RFA) and 4 transarterial chemoembolization (TACE). Cumulative 1-, 3-, and 5-year patient survivals were 62%, 54%, and 43%, respectively in HCC/HCV-positive patients and they were 74%, 67%, and 61% among non-HCC HCV-positive subjects. The cumulative HCC patient survival rates of 64%, 64%, and 53% among Milan criteria were superior to those of 57%, 40%, and 27% among subjects exceeding the Milan criteria (P=.01). Pre-OLT "down-staging" treatment increased the 1-year patient survival from 64% to 70%; however, it did not affect the long-term results. Among items of the Milan criteria tumor size had less impact on outcomes then number of foci. The majority of cases who exceeded the Milan criteria had been transplanted before 2003. Our results suggested that the Milan criteria should be applied for the selection of candidates in order to promise good survival after OLT for HCC.

Acute liver failure (ALF) counts for 9%-11% of activity in leading liver transplant programs. We have summarized the Hungarian Liver Transplant Program experience for ALF among 412 consecutive orthotopic liver transplantations (OLTs). All OLTs were performed without an extended international donor background. The proportion of ALF among the indications for OLT was lower (5.8% vs 9%) and early mortality higher than the European Liver Transplant Registry (1 year cumulative patients survival is 70% in ELTR vs 60% in the HU LT Program). The waiting time for a donor was longer than expected in the Eurotransplant community. Regarding postoperative complications, there was a higher incidence of initial poor function, bacterial infection, sepsis, and multiorgan failure. We conclude that ALF can be managed with reasonable results but requires an extended donor pool with an integrated international network to improve postoperative morbidity and mortality.

Introduction Recurrence of primary sclerosing cholangitis (rPSC) after liver transplantation (OLT) significantly affects longterm graft survival. We aimed to evaluate the incidence of rPSC and clinical data of these patients in Hungary. Patients and Methods We retrospectively analyzed data of 511 whole liver transplantations from 1995 to 2011. During the study period, 49 OLTs were performed in 43 adult patients with end-stage PSC (10%). Results Out of 49 OLT, 24 cases were excluded, rPSC was diagnosed in six patients (12%). Patients with rPSC had significantly higher mortality (p = 0.009) and graft loss (p = 0.009) in comparison to patients without recurrent disease. Younger recipient age, higher donor BMI was observed in the rPSC group. One patient was diagnosed with de novo IBD, the remaining five patients had worsening IBD activity in the posttransplant period. PreOLT colectomy was performed in 21% of the control and none of the rPSC group. PostOLT colectomy was performed in two rPSC patients due to severe therapy resistant colitis. Conclusions Recurrent PSC significantly affects long-term mortality and graft loss. Younger age at OLT, higher donor BMI and severe active IBD may be associated with PSC recurrence. PreOLT total colectomy might have protective effect against rPSC.

In liver cirrhosis renal function decreases as well. Hepatorenal syndrome is the most frequent cause of the decrease, but primary kidney failure, diabetes mellitus and some diseases underlying endstage liver failure (such as hepatitis C virus infection) can also play an important role. In liver transplantation several further factors (total cross-clamping of vena cava inferior, polytransfusion, immunosuppression) impair the renal function, too.The aim of this study was to analyse the changes in kidney function during the first postoperative year after liver transplantation.Retrospective data analysis was performed after primary liver transplantations (n = 319).impaired preoperative renal function increased the devepolment of postoperative complications and the first year cumulative patient survival was significantly worse (91,7% vs 69,9%; p0,001) in this group. If renal function of the patients increased above 60 ml/min/1,73 m2 after the first year, patient survival was better. Independently of the preoperative kidney function, 76% of the patients had impaired kidney function at the first postoperative year. In this group, de novo diabetes mellitus was more frequently diagnosed (22,5% vs 9,5%; p = 0,023).Selection of personalized immunosuppressive medication has a positive effect on renal function.Bevezetés: Májcirrhosisban a vesefunkció is romlik. Ennek hátterében leggyakrabban hepatorenalis szindróma áll, de primer vesebetegség, diabetes mellitus, valamint egyes alapbetegségek is okozhatják (például hepatitis C-vírus-fertőzés). Májtranszplantáció során számos további esemény (teljes vena cava kirekesztés, politranszfúzió, immunszuppresszió) is eredményezheti a veseműködés romlását. Célkitűzés: A veseműködés változásának vizsgálata májtranszplantációt követően a posztoperatív első év alatt. Módszer: Primer májátültetésen átesett betegek (n = 319) adatait dolgozták fel retrospektív adatelemzéssel. Eredmények: Ha a veseműködés már preoperatív beszűkült volt, egyes posztoperatív szövődmények gyakrabban alakultak ki, és rosszabb volt az egyéves kumulatív betegtúlélés (91,7% vs. 69,9%; p0,001). Ha az első év után a glomerulusfiltrációs ráta 60 ml/perc/1,73 m2 fölé emelkedett, javult a betegtúlélés. Függetlenül a vese preoperatív állapotától, az első év végig a betegek nagyobb részének (76%) romlott a veseműködése. Ebben a betegcsoportban gyakrabban alakult ki de novo diabetes mellitus (22,5% vs. 9,5%; p = 0,023). Következtetések: A veseelégtelenség kialakulásában jelentős szerepet játszó kockázati tényezők közül leginkább a személyre szabott immunszuppressziós terápia megválasztásán keresztül érhető el kedvező hatás. Orv. Hetil., 2013, 154, 1018–1025.

Besides orthotopic liver transplantation (OLT) there is no long-term and effective replacement therapy for severe liver failure. Artificial extracorporeal liver supply devices are able to reduce blood toxin levels, but do not replace any synthetic function of the liver. Molecular adsorbent recirculating system (MARS) is one of the methods that can be used to treat fulminant acute liver failure (ALF) or acute on chronic liver failure (AoCLF). The primary non-function (PNF) of the newly transplanted liver manifests in the clinical settings exactly like acute liver failure. MARS treatment can reduce the severity of complications by eliminating blood toxins, so that it can help hepatic encephalopathy (HE), hepatorenal syndrome (HRS), and the high rate mortality of cerebral herniation. This might serve as a bridging therapy before orthotopic liver retransplantation (reOLT). Three patients after a first liver transplantation became candidate for urgent MARS treatment as a bridging solution prior to reOLT in our center. Authors report these three cases, focusing on indications, MARS sessions, clinical courses, and final outcomes.

Biliary complications (BC) significantly affect morbidity and mortality after orthotopic liver transplantation (OLT). The aim of this study was to analyze the incidence and types of biliary complications after OLT in Hungary. We retrospectively analyzed data of 471 adult liver transplant recipients between 1995 and 2011. Biliary complications occurred in 28% of patients. The most frequent BCs were bile duct stricture, stenosis (19%), biliary leakage (12%), and necrosis (BN: 6.4%). Biliary complications were associated with the incidence of acute rejection (51% vs 31%; P = .003), hepatic artery thrombosis (43% vs 11%; P < .001), and hepatic artery stenosis (26% vs 11%; P = .002). When cold ischemic time was longer than 12 hours, leakage (10% vs 3%; P = .043), ischemic type biliary lesion (20% vs 3.4%; P = .05), and BN (12% vs 3%; P = .067) were more often diagnosed post-OLT. Most of the biliary complications were treated by radiologic interventions (70%). Bile duct necrosis was associated with lower graft and patient survival. In conclusion, acute rejection, hepatic artery thrombosis/stenosis and cold ischemic time longer than 12 hours increase the incidence of BCs. Successful management of these risk factors can reduce the incidence of biliary complications and improve mortality.

Hepatic artery thrombosis (HAT) significantly affects graft loss and mortality after orthotopic liver transplantation (OLT). The aim of this study was to analyze the risk factors of HAT in our program, with special regard to the personal-technical factor. We retrospectively analyzed the data of 500 adult liver transplant recipients between 1995 and 2011. Operations were performed by a certain group of surgeons, with standardized technique. The incidence rate of HAT decreased since 1995 from 12% to 7.8%. In accordance with the literature, HAT associated with acute rejection, polytransfusion, and the duration of the hepatectomy, arterial variations/reconstructions, tiny arteries, and furthermore, the timing of the anastomosis in Hungary. However we did not find an association with other parameters, like cytomegalovirus infection, and hepatocellular carcinoma as indication. We created a “difficulty index” that consists of the technical parameters. The difficulty index together with surgical experience (number of OLTs performed) had an outstanding association with HAT. In conclusion, the incidence and risk factors for HAT are similar to the results published by others. However, personal factors, such as experience, timing, given anatomy, and tiredness, might also play a significant role in the occurrence of HAT.

The possibility that endocrine factors may influence the clinical course of malignant melanoma is suggested by the superior survival data of women. In preclinical models we observed a higher rate of colony formation by human melanoma cells in male compared to female SCID mice, but only in the case of the liver and not in other organs. The gender difference could be seen at an early phase of colony formation. On the other hand, in our human melanoma cell lines we failed to detect steroid receptor protein expression, and treatment with sex hormones did not considerably influence their in vitro behavior. Investigating the possible contribution of host cells to the observed gender difference, we performed in vivo blocking experiments applying pretreatment of the animals with Kupffer cell inhibitor gadolinium chloride and the NK cell inhibitor anti-asialo GM1 antibody. While Kupffer cell blockade enhanced melanoma liver colonization equally in the two sexes, a more prominent increase was observed in female than in male mice in the case of NK cell inhibition. Further supporting the importance of NK cells in the lower liver colonization efficiency of melanoma cells in females, gender difference in colony formation was lost in NSG mice lacking NK activity. Although in humans no organ selectivity of gender difference in melanoma progression has been observed according to data in the literature, our results possibly indicate a contribution of natural host defense mechanisms to gender difference in survival of patients with melanoma or other tumor types as well.

The cell adhesion molecule claudin-1 (CLDN-1) is a well known co-factor for the cell entry of hepatitis C virus (HCV). We examined 24 hepatic biopsies from liver transplant patients. Reverse transcriptase polymerase chain reaction (RT-PCR) and immunohistochemistry were performed according to standard procedures. RT-PCR results were shown as relative expression (ΔCT) with beta-actin as the reference gene. Immunohistochemistry results are shown by morphometry. The CLDN-1 mRNS expression rate was significantly lower when the patient displayed favorably with an unsatisfactory to antiviral therapy 0.756 ± 0.249 versus 1.304 ± 0.28 (P = .012). There was also a strong positive correlation between CLDN-1 protein expression and liver fibrosis (Pearson correlation coefficients: r = 0.476; P = .034).

A szerzők összefoglalják a magyar májátültetési program epeúti szövődményeinek jellemzőit. Feltárják az epeúti szövődmények előfordulási gyakoriságát. Elemzik az epeúti szövődmények típusait és azok megoszlását, valamint hatásukat a beteg-, illetve graftvesztésre. Elemzik az irodalomban már ismert rizikófaktorokat a hazai betegpopulációban. Ismertetik az epeúti szövődmények kezelési lehetőségeit. Retrospektív vizsgálat során a betegeket két csoportba osztották aszerint, hogy a májátültetés után kialakult-e epeúti szövődmény, vagy nem, majd a két csoportot összehasonlították számos vizsgált paraméter, valamint a túlélések szempontjából. Az epeúti szövődményes betegeket tovább csoportosították annak alapján, hogy a szövődmény a májátültetés után három hónapon belül vagy később alakult ki. Ezt a két csoportot szintén összehasonlították a fentebb említett kontrollcsoporttal. Egyvariációs összehasonlítások esetén a folytonos adatokat a populáció homogenitásának vizsgálata után (Levene-teszt) kétmintás t -próbával, illetve Mann–Whitney-féle U-teszttel, a kategorikus adatokat χ 2 -próbával, illetve Kaplan–Meier-analízissel vizsgálták. A túlélést Kaplan–Meier-metodikával vizsgálták. Az eredményeket valamennyi statisztikai próbánál akkor tekintették szignifikánsnak, ha a p < 0,05 volt. Eredmények: Epeúti szövődmény a betegek 26%-ában jelent meg, 290 vizsgált beteg közül 76 esetben. A leggyakoribb a szűkület (18%), majd az epecsorgás (9%), a necrosis (6%), végül az ischaemiás típusú epeúti károsodás (3%). Epeúti szövődmények esetén az 5 éves kumulatív túlélés rosszabb (55%), mint ezek hiányában (66%), és a retranszplantációk aránya is magasabb (15%) volt. A leggyakoribb kezelési típusok: intervenciós radiológiai (69%), sebészi (17%), ERCP (14%). Következtetések: Az epeúti szövődmények aránya megfelel a nemzetközi közléseknek, 2002 óta arányuk csökkent. Epeúti szövődmények kialakulásának rizikófaktorai: cholangitis, az arteria hepatica thrombosisa és stenosisa, magas bevitt intraoperatív volumen, valamint az akut rejectio. Korai epeúti szövődmények gyakran társultak a beültetett májgraft kezdeti gyenge működésével (ún. „initial poor function”). A korai epeúti szövődmények felelősek a túlélés csökkenéséért, a késői szövődmények inkább az életminőséget rontják. Az epeúti szövődményes betegeket döntően intervenciós radiológiai módszerekkel kezelték.

Recurrence of hepatitis C virus (HCV) after liver transplantation (OLT) occurs consistently. Early initiation of combined antiviral treatment (AVT) has become a standard treatment seeking to achieve sustained virological response (SVR). We evaluated the files of 108 HCV-positive patients between 2003 and 2010. Seventy-two (72) experienced recurrent HCV within 12 months, 31 of whom completed the AVT (43%) but 9 (29%) exhibited SVR. Factors with impacting SVR were male recipient, no fatty changes in the donor liver, short warm ischemia time, cyclosporine-based immunosuppression, neither infective, septic or bleeding complication nor acute rejection episode and a rapid viral response to AVT. De novo diabetes, and unsuccessful AVT prior to OLT were strongly associated with a a failed SVR. The 1- and 3-year cumulative patient survival rates trended to be better in cases of SVR compared with nonresponders (100% and 100% versus 94% and 89%; P = .07).

De novo diabetes mellitus is a common complication after liver transplantation. It is strongly associated with hepatitis C virus (HCV) infection. We analyzed the relationship between HCV recurrence and de novo diabetes among the Hungarian liver transplant population. This retrospective study included cases from 1995 to 2009 on 310 whole liver transplantations. De novo diabetes was defined if the patient had a fasting plasma glucose ≥126 mg/dL permanently after the third month post liver transplantation, and/or required sustained antidiabetic therapy. De novo diabetes occured in 63 patients (20%). The cumulative patient survival rates at 1, 3, 5, and 8 years were 95%, 91%, 88%, and 88% in the control group, and 87%, 79%, 79%, and 64% in the de novo group, respectively ( P = .011). The majority of the patients in the de novo group were HCV positive (66% vs 23%). Early virus recurrence within 5 months was associated with the development of diabetes (80% vs 20% non-diabetic controls; P = .017). The fibrosis (2.05 ± 1.5 vs 1 ± 1; P = .039) and Knodell scores (3.25 ± 2 vs 1.69 ± 1.2; P = .019) were higher among the de novo group after antiviral therapy. Rapid recurrence, more severe viremia, and fibrosis showed significant roles in the developement of de novo diabetes after liver transplantation.