40 results on '"Gergely Zádori"'
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2. Ureteral Complications Requiring Intervention After Kidney Transplant: A Single-Center Experience
- Author
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Lóránt, Illésy, Dávid Ágoston, Kovács, Roland, Fedor, Gergely, Zádori, Zsolt, Kanyári, László, Asztalos Sen, and Balázs, Nemes
- Subjects
Transplantation ,Surgery - Abstract
The surgical aspect of kidney transplant can be the surgical technique itself or the use of reconstruction techniques in the case of a complication requiring reoperation. In our study, we examined particularly surgical techniques and reconstruction options for ureteral anastomoses. Data from patients who underwent kidney transplant from 2010 to 2020 (N = 433) were examined retrospectively at follow-up of at least 1 year. We sought an association between the type of ureteral anastomoses and parameters considered to be risk factors based on literature data. We did not note the complicated cases that solved spontaneously and only selected cases where the ureteral anastomosis complication (UAcomp) needed urologic, radiological, or surgical intervention. In a smaller group, we examined the correlation between BK polyomavirus and ureteral stenosis. A total of 9.2% (n = 40) of patients developed UAcomp, 67.5% (n = 27) of whom required reoperation. In complicated cases, the rate of primary ureteral anastomosis type was 60.0% (n = 24) ureteroneocystostomy (UNS) and 40.0% (n = 16) ureteroureterostomy (UU) (P = .184). After UNS, 7.7% (n = 17) of cases required reoperation, and this rate was 4.7% (n = 10) after UU (P = .164). After treatment of the UAcomp, 95.0% (n = 38) of the patients were discharged with a functioning graft, and 5.0% (n = 2) required graftectomy. Complications of ureteral anastomosis with appropriate interventions results in good graft function. The type of ureteral anastomosis is not significantly associated with UAcomp. It is important that the operating surgeon is well versed in UNS and UU techniques to be able to adapt to any situation, be it primary surgery or reoperation.
- Published
- 2022
3. Veseátültetés utáni sebészeti szövődmények előfordulása a Clavien-beosztás szerint, különös tekintettel a húgyvezeték-anastomosis típusára
- Author
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Richárd Veisz, Judit Tóth, Lóránt Illésy, Márton Kovács, Gergely Zádori, Balázs Nemes, Ivett Belán, D. Kovács, Zsolt Kanyári, Tibor Flaskó, R. Fedor, and Gergő József Szőllősi
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,General Medicine ,Anastomosis ,medicine.disease ,Delayed Graft Function ,Surgery ,Ureter ,medicine.anatomical_structure ,Renal transplant ,Medicine ,Complication ,business ,Kidney transplantation ,Severe complication - Abstract
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.
- Published
- 2021
4. Miért az elsMiért az első választás számos sebészeti kórkép kezelésében a negatívnyomás-terápia az általános sebészeti gyakorlatban? Irodalmi áttekintés választás számos sebészeti kórkép kezelésében a negatívnyomás-terápia az általános sebészeti gyakorlatban? Irodalmi áttekintés.
- Author
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ZSOLT, SZENTKERESZTY, PÉTER, KOLOZSI, GERGELY, ZÁDORI, ZSOLT, SUSÁN, CSABA, ÖTVÖS, ATTILA, ENYEDI, and DEZSŐ, TÓTH
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SOFT tissue infections ,OPERATIVE surgery ,NEGATIVE-pressure wound therapy ,MEDICAL protocols ,TREATMENT effectiveness ,INTRA-abdominal hypertension ,COST effectiveness ,QUALITY of life ,WOUNDS & injuries ,ABDOMINAL injuries ,ESOPHAGUS diseases ,WOUND care - Abstract
Copyright of Lege Artis Medicine (LAM) is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2023
- Full Text
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5. Surgical complications after kidney transplantation based on the Clavien classification, especially with regard to the types of ureteral anastomoses
- Author
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Lóránt, Illésy, Roland, Fedor, Dávid Ágoston, Kovács, Zsolt, Kanyári, Gergely, Zádori, Gergő József, Szőllősi, Márton, Kovács, Tibor, Flaskó, Judit, Tóth, Richárd, Veisz, Ivett, Belán, and Balázs, Nemes
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Adult ,Male ,Postoperative Complications ,Humans ,Middle Aged ,Kidney Transplantation ,Retrospective Studies - Abstract
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.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.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.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.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.
- Published
- 2021
6. Hydatid disease of pancreas: A case report
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Zsolt Szentkereszty, László Damjanovich, János Deák, Adrienn Csiszkó, and Gergely Zádori
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medicine.medical_specialty ,echinococcus ,medicine.medical_treatment ,Case Report ,Disease ,030230 surgery ,Asymptomatic ,surgery ,03 medical and health sciences ,0302 clinical medicine ,Laparotomy ,parasitic diseases ,medicine ,Cyst ,pancreas ,cyst ,biology ,business.industry ,General Medicine ,medicine.disease ,biology.organism_classification ,hydatidosis ,medicine.anatomical_structure ,Echinococcus ,Uncinate process of pancreas ,030211 gastroenterology & hepatology ,Radiology ,medicine.symptom ,Pancreas ,business ,Calcification - Abstract
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.
- Published
- 2019
7. Surgical Complications Following Kidney Transplantations: A Single-Center Study in Hungary
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Balázs Nemes, Zsolt Kanyári, R. Fedor, F. Toth, Gergely Zádori, Lóránt Illésy, M. Szabo-Pap, and D. Kovács
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Adult ,Male ,medicine.medical_specialty ,030232 urology & nephrology ,Anastomosis ,Klinikai orvostudományok ,Single Center ,Renal artery stenosis ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Ureter ,Risk Factors ,medicine ,Humans ,Kidney transplantation ,Retrospective Studies ,Hungary ,Transplantation ,business.industry ,Incidence ,Incidence (epidemiology) ,Graft Survival ,Retrospective cohort study ,Orvostudományok ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Complication ,business - Abstract
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).
- Published
- 2016
8. Bacterial Infections After Kidney Transplantation: A Single-Center Experience
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Lóránt Illésy, Gergely Zádori, László Asztalos, Balázs Nemes, M. Szabo-Pap, R. Fedor, Réka P. Szabó, Lajos Zsom, and F. Toth
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Urinary system ,030106 microbiology ,Klinikai orvostudományok ,Single Center ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Hospital ward ,Kidney transplantation ,Retrospective Studies ,Transplantation ,Kidney ,business.industry ,Graft Survival ,Retrospective cohort study ,Orvostudományok ,Bacterial Infections ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Surgery ,medicine.anatomical_structure ,Female ,business - Abstract
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.
- Published
- 2016
9. Graftectomiák a debreceni vesetranszplantációs programban
- Author
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Zsolt Kanyári, Gergely Zádori, László Damjanovich, R. Fedor, Csaba Ötvös, Balázs Nemes, D. Kovács, Fruzsina Tóth, Zsolt Kincses, and László Asztalos
- Subjects
Gynecology ,medicine.medical_specialty ,Graft rejection ,business.industry ,030232 urology & nephrology ,Orvostudományok ,General Medicine ,030230 surgery ,Klinikai orvostudományok ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,medicine ,Graft survival ,business - Abstract
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.
- Published
- 2016
10. Donorszelekciós kritériumok vizsgálata a debreceni veseátültetési programban
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R. Fedor, Réka P. Szabó, László Asztalos, Vera Tarjányi, D. Kovács, Lajos Zsom, Zsolt Kanyári, Gergely Zádori, and Balázs Nemes
- Subjects
Gynecology ,medicine.medical_specialty ,Graft rejection ,Donor selection ,business.industry ,Treatment outcome ,Orvostudományok ,General Medicine ,030230 surgery ,Klinikai orvostudományok ,medicine.disease ,Expanded Criteria Donor ,03 medical and health sciences ,0302 clinical medicine ,Marginal donor ,medicine ,030211 gastroenterology & hepatology ,Graft survival ,business ,Kidney transplantation - Abstract
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.
- Published
- 2016
11. Pregnancy management of women with kidney transplantation
- Author
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Anita Záhonyi, Katalin Jenei, László Asztalos, Krisztina Kabai, D. Kovács, Balázs Nemes, László Szabó, Gergely Zádori, R. Fedor, and Lajos Zsom
- Subjects
Infertility ,Gynecology ,medicine.medical_specialty ,Fetus ,Pregnancy ,Obstetrics ,business.industry ,Case Report ,Orvostudományok ,General Medicine ,Klinikai orvostudományok ,medicine.disease ,Uremia ,Transplantation ,Sexual dysfunction ,medicine ,Gestation ,medicine.symptom ,business ,Kidney transplantation - Abstract
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.
- Published
- 2015
12. Negatívnyomás-terápia Covid-19-pandémia idején: fasciitis necrotisans és retroperitonealis tályog kezelése.
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GERGELY, ZÁDORI, ZSOLT, SUSÁN, ZSIGMOND, TÓTH CSABA, DEZSÔ, TÓTH, and ZSOLT, SZENTKERESZTY
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ABSCESS treatment ,ANTIBIOTICS ,RETROPERITONEUM ,ABDOMINAL abscess ,NEGATIVE-pressure wound therapy ,COMPUTED tomography ,COVID-19 pandemic ,NECROTIZING fasciitis - Abstract
Copyright of Lege Artis Medicine (LAM) is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2021
13. A Single-center Experience of Allograft Nephrectomies Following Kidney Transplantation
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R. Fedor, Balázs Nemes, Zsolt Kanyári, László Asztalos, M. Szabo-Pap, Lóránt Illésy, D. Kovács, Gergely Zádori, and F. Toth
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,030232 urology & nephrology ,030230 surgery ,Single Center ,Klinikai orvostudományok ,Nephrectomy ,03 medical and health sciences ,0302 clinical medicine ,Ureter ,Hematoma ,Chronic allograft nephropathy ,medicine ,Humans ,Transplantation, Homologous ,Kidney transplantation ,Retrospective Studies ,Transplantation ,business.industry ,Retrospective cohort study ,Orvostudományok ,Middle Aged ,medicine.disease ,Allografts ,Thrombosis ,Kidney Transplantation ,Surgery ,Stenosis ,medicine.anatomical_structure ,Female ,Kidney Diseases ,business - Abstract
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.
- Published
- 2016
14. MicroRNA profile before and after antiviral therapy in liver transplant recipients for hepatitis C virus cirrhosis
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Zsuzsanna Gerlei, Gábor Lendvai, Matteo Fassan, Gergely Zádori, Zsuzsa Schaff, Eniko Sárváry, Fanni Gelley, Attila Doros, Balázs Nemes, Peter Nagy, and András Kiss
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Regulation of gene expression ,Cirrhosis ,Hepatology ,business.industry ,Hepatitis C virus ,medicine.medical_treatment ,Gastroenterology ,virus diseases ,Liver transplantation ,medicine.disease_cause ,medicine.disease ,Virology ,digestive system diseases ,microRNA ,Immunology ,Medicine ,Scavenger receptor ,Receptor ,business ,CD81 - Abstract
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.
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- 2013
15. Gerundium: A Comprehensive Public Educational Program on Organ Donation and Transplantation and Civil Law in Hungary
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R. Fedor, Lajos Zsom, K. Rajczy, K. Eszter, Balázs Nemes, S. Mihály, D. Kovács, B. Enikő, László Asztalos, and Gergely Zádori
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Male ,medicine.medical_specialty ,Students, Medical ,Tissue and Organ Procurement ,Adolescent ,media_common.quotation_subject ,education ,Health Promotion ,Klinikai orvostudományok ,Organ transplantation ,Presentation ,Pedagogy ,Humans ,Medicine ,Organ donation ,Program Development ,media_common ,Hungary ,Transplantation ,Medical education ,Schools ,Education, Medical ,business.industry ,Orvostudományok ,Organ Transplantation ,Middle Aged ,Tissue Donors ,Health promotion ,Life expectancy ,Female ,Surgery ,business ,Educational program ,Peer education - Abstract
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.
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- 2015
16. Hepatitis C virus recurrence after liver transplantation in Hungary. Trends over the past 10 years
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Attila Doros, László Kóbori, János Schuller, Zsuzsanna Gerlei, Peter Nagy, Balázs Nemes, Dénes Görög, György Gámán, Gergely Zádori, Gabriella Lengyel, Enikő Sárváry, János Fazakas, Fanni Gelley, András Kiss, László Szőnyi, Zsuzsa Schaff, and Imre Fehérvári
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Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Time Factors ,Hepacivirus ,Hepatitis C virus ,medicine.medical_treatment ,Treatment outcome ,Liver transplantation ,medicine.disease_cause ,Gastroenterology ,Recurrence ,Internal medicine ,Diabetes Mellitus ,medicine ,Humans ,Antiviral treatment ,Retrospective Studies ,Hungary ,Graft rejection ,biology ,business.industry ,Incidence ,Graft Survival ,General Medicine ,Hepatitis C ,Middle Aged ,medicine.disease ,biology.organism_classification ,Survival Analysis ,Virology ,Liver Transplantation ,Treatment Outcome ,Acute Disease ,Female ,Graft survival ,business - Abstract
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.
- Published
- 2013
17. [Allograft nephrectomy - a single-center experience]
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Fruzsina, Tóth, Gergely, Zádori, Roland, Fedor, Dávid Ágoston, Kovács, Zsolt, Kanyári, Zsolt, Kincses, Csaba, Ötvös, László, Damjanovich, László, Asztalos, and Balázs, Nemes
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Adult ,Graft Rejection ,Male ,Hungary ,Time Factors ,Adolescent ,Graft Survival ,Middle Aged ,Allografts ,Kidney Transplantation ,Nephrectomy ,Elective Surgical Procedures ,Risk Factors ,Humans ,Female ,Aged ,Retrospective Studies - Abstract
Indication and timing of allograft nephrectomy is still uncertain in some cases.The aim of the authors was to summarize their experience with graftectomies.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.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.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.
- Published
- 2016
18. [Analysis of donor scoring systems in a single Hungarian transplant centre]
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Gergely, Zádori, Vera, Tarjányi, Réka, P Szabó, Lajos, Zsom, Roland, Fedor, Zsolt, Kanyári, Dávid Ágoston, Kovács, László, Asztalos, and Balázs, Nemes
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Adult ,Graft Rejection ,Male ,Hungary ,Graft Survival ,Middle Aged ,Kidney Transplantation ,Tissue Donors ,Donor Selection ,Treatment Outcome ,Risk Factors ,Cadaver ,Living Donors ,Humans ,Female ,Aged ,Retrospective Studies - Abstract
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.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.Analysis of the characteristics of 138 kidney transplantations and 205 donors in a retrospective study of a five-year period.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.With the use of these scoring systems grafts with favourable outcome can be selected more precisely.
- Published
- 2016
19. [First outcomes, since being full member of Eurotransplant. A single center experience of cadaveric kidney transplantation]
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Balázs, Nemes, Roland, Fedor, Zsolt, Kanyári, Lajos, Lőcsey, Ferenc, Juhász, Dávid Ágoston, Kovács, Gergely, Zádori, Ferenc, Győry, Réka, P Szabó, Lajos, Zsom, Tamás, Szabó, Lóránt, Illésy, Marcell, Szabó-Pap, Zsolt, Kincses, László, Szabó, László, Damjanovich, József, Balla, and László, Asztalos
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Adult ,Graft Rejection ,Immunosuppression Therapy ,Male ,Hungary ,Incidence ,Graft Survival ,Comorbidity ,Middle Aged ,Kidney Transplantation ,Europe ,Postoperative Complications ,Cadaver ,Living Donors ,Humans ,Kidney Failure, Chronic ,Female ,Retrospective Studies - Abstract
The first renal transplantation was completed in 1991 at the University of Debrecen. In 2013 Hungary joined Eurotransplant.The authors retrospectively compared the trends.Comparison between Period A (from January 1, 2008 to August 31, 2013) and Period B (from September 1, 2013 to October 22, 2015).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/m(2) 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.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.
- Published
- 2016
20. Eredményeink a teljes jogú Eurotransplant-tagság óta: a Debreceni Vesetranszplantációs Központ tapasztalatai
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Laszlo Szabo, D. Kovács, Ferenc Győry, László Damjanovich, Balázs Nemes, Ferenc Juhasz, Tamás Szabó, Marcell Szabó-Pap, Gergely Zádori, L. Lőcsey, R. Fedor, Lajos Zsom, Zsolt Kanyári, Réka P. Szabó, Zsolt Kincses, László Asztalos, Lóránt Illésy, and József Balla
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medicine.medical_specialty ,Graft rejection ,business.industry ,General Medicine ,Orvostudományok ,030230 surgery ,Klinikai orvostudományok ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,030211 gastroenterology & hepatology ,Graft survival ,business - Abstract
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.
- Published
- 2016
21. Acute liver transplantation in a 41-year-old male patient presenting symptoms of adult-onset Still's disease
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Tamás Micsik, Imre Fehérvári, András Gelley, Balázs Nemes, Gergely Zádori, Attila Doros, János Fazakas, Zsófia Müller, and Fanni Gelley
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Pediatrics ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Hepatosplenomegaly ,Orvostudományok ,General Medicine ,Liver transplantation ,Klinikai orvostudományok ,Neutrophilia ,Surgery ,Fulminate ,chemistry.chemical_compound ,chemistry ,Sore throat ,Maculopapular rash ,Medicine ,Leukocytosis ,medicine.symptom ,Differential diagnosis ,business - Abstract
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.
- Published
- 2011
22. Outcome of Liver Transplantation Based on Donor Graft Quality and Recipient Status
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László Kóbori, Dénes Görög, Imre Fehérvári, Balázs Nemes, László Piros, J. Perneczky, Gergely Zádori, and Fanni Gelley
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Hepatitis C virus ,Hepacivirus ,Liver transplantation ,Klinikai orvostudományok ,medicine.disease_cause ,Risk Assessment ,Gastroenterology ,Group B ,Liver disease ,Postoperative Complications ,Internal medicine ,medicine ,Humans ,Renal Insufficiency ,Survival analysis ,Retrospective Studies ,Transplantation ,Kidney ,business.industry ,Graft Survival ,Retrospective cohort study ,Orvostudományok ,Length of Stay ,medicine.disease ,Hepatitis C ,Survival Analysis ,Tissue Donors ,Liver Transplantation ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Female ,business ,Liver Failure - Abstract
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.
- Published
- 2010
23. Can a Cutoff Value for Cystatin C in the Operative Setting Be Determined to Predict Kidney Function After Liver Transplantation?
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Attila Doros, Eniko Sárváry, Gergely Zádori, Fanni Gelley, Balázs Nemes, Dénes Görög, and György Gámán
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Adult ,Graft Rejection ,medicine.medical_specialty ,medicine.medical_treatment ,Urinary system ,Urology ,Renal function ,Liver transplantation ,Anuria ,Kidney Function Tests ,Klinikai orvostudományok ,urologic and male genital diseases ,chemistry.chemical_compound ,Postoperative Complications ,Predictive Value of Tests ,Monitoring, Intraoperative ,Sepsis ,medicine ,Humans ,Treatment Failure ,Cystatin C ,reproductive and urinary physiology ,Kidney transplantation ,Transplantation ,Creatinine ,Kidney ,biology ,Operative Blood Salvage ,urogenital system ,business.industry ,Graft Survival ,Orvostudományok ,Middle Aged ,medicine.disease ,female genital diseases and pregnancy complications ,Diuresis ,Liver Transplantation ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,chemistry ,biology.protein ,Cystatin ,business ,Glomerular Filtration Rate - Abstract
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.
- Published
- 2010
24. New-onset diabetes mellitus after liver transplantation
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Imre Fehérvári, László Kóbori, Balázs Nemes, Gergely Zádori, Fanni Gelley, János Fazakas, Katalin Földes, Zsuzsa Schaff, Simon Pápai, Enikő Sárváry, Zsuzsanna Gerlei, Dénes Görög, Gábor Firneisz, Peter Nagy, Attila Doros, and Gabriella Lengyel
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medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,medicine.medical_treatment ,Hepatitis C virus ,General Medicine ,Liver transplantation ,medicine.disease_cause ,Gastroenterology ,Endocrinology ,New onset diabetes ,Sex factors ,Internal medicine ,medicine ,Graft survival ,business ,Survival analysis - Abstract
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.
- Published
- 2010
25. The role of marginal donors in liver transplantation. The Hungarian experience
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Tamás Mándli, Zsuzsa Gerlei, Imre Fehérvári, Attila Doros, Enikő Sárváry, Balázs Nemes, Gergely Zádori, János Fazakas, Dénes Görög, Fanni Gelley, László Kóbori, and Katalin Jakab
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medicine.medical_specialty ,Tissue and Organ Procurement ,medicine.medical_treatment ,Biology ,Liver transplantation ,Gastroenterology ,Body Mass Index ,Donor Selection ,Liver Function Tests ,Ischemia ,Recurrence ,Internal medicine ,medicine ,Humans ,Hungary ,Hypernatremia ,medicine.diagnostic_test ,Donor selection ,Graft Survival ,Age Factors ,General Medicine ,Hepatitis C ,Length of Stay ,medicine.disease ,Survival Analysis ,Tissue Donors ,Liver Transplantation ,Surgery ,Intensive Care Units ,Marginal donor ,Graft survival ,Hypotension ,Liver function tests - Abstract
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.
- Published
- 2009
26. Results of Expanded-Criteria Donor Kidneys: A Single-Center Experience in Hungary
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Zsolt Kanyári, D. Kovács, László Asztalos, R. Fedor, Gergely Zádori, Lajos Zsom, and Balázs Nemes
- Subjects
Adult ,Male ,medicine.medical_specialty ,genetic structures ,Delayed Graft Function ,Klinikai orvostudományok ,Expanded Criteria Donor ,Single Center ,Kidney ,Donor Selection ,chemistry.chemical_compound ,medicine ,Humans ,Kidney transplantation ,Aged ,Retrospective Studies ,Transplantation ,Creatinine ,Hungary ,Donor selection ,business.industry ,Graft Survival ,Retrospective cohort study ,Orvostudományok ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Tissue Donors ,Surgery ,Stroke ,surgical procedures, operative ,Treatment Outcome ,chemistry ,Hypertension ,Female ,Cadaveric spasm ,business - Abstract
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.
- Published
- 2015
27. Horseshoe kidney transplantation
- Author
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Zsolt Kanyári, Mariann Berhes, Matyas Hamar, Lajos Zsom, Balázs Nemes, Krisztina Kóbor, Antal Péter, and Gergely Zádori
- Subjects
Kidney ,medicine.medical_specialty ,business.industry ,Urinary system ,Horseshoe kidney ,Case Report ,General Medicine ,Orvostudományok ,medicine.disease ,Klinikai orvostudományok ,Inferior vena cava ,Urinoma ,Surgery ,Transplantation ,Ureter ,medicine.anatomical_structure ,medicine.vein ,Duplicated ureter ,medicine ,business - Abstract
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.
- Published
- 2015
28. The Impact of Milan Criteria on Liver Transplantation for Hepatocellular Carcinoma: First 15 Years' Experience of the Hungarian Liver Transplant Program
- Author
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Eniko Sárváry, László Kóbori, Imre Fehérvári, Pál Nagy, Attila Doros, Gergely Zádori, László Piros, Balázs Nemes, Dénes Görög, Fanni Gelley, and András Kiss
- Subjects
medicine.medical_specialty ,Carcinoma, Hepatocellular ,Time Factors ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Liver transplantation ,Milan criteria ,Klinikai orvostudományok ,Severity of Illness Index ,Gastroenterology ,Predictive Value of Tests ,Internal medicine ,medicine ,Carcinoma ,Health Status Indicators ,Humans ,Survival rate ,Neoplasm Staging ,Hungary ,Transplantation ,business.industry ,Patient Selection ,Liver Neoplasms ,Orvostudományok ,Hepatitis C ,medicine.disease ,digestive system diseases ,Liver Transplantation ,Surgery ,Survival Rate ,Treatment Outcome ,surgical procedures, operative ,Predictive value of tests ,Hepatocellular carcinoma ,Liver cancer ,business ,Immunosuppressive Agents ,Program Evaluation - Abstract
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.
- Published
- 2011
29. Liver Transplantation for Acute Liver Failure: The Hungarian Experience
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Balázs Nemes, Robert M. Langer, László Kóbori, Dénes Görög, Imre Fehérvári, and Gergely Zádori
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Adult ,Male ,Waiting time ,medicine.medical_specialty ,Time Factors ,Adolescent ,Waiting Lists ,Multiple Organ Failure ,medicine.medical_treatment ,Liver transplantation ,Klinikai orvostudományok ,Sepsis ,Young Adult ,medicine ,Humans ,Child ,Donor pool ,Hungary ,Transplantation ,International network ,business.industry ,Incidence (epidemiology) ,digestive, oral, and skin physiology ,Liver failure ,Orvostudományok ,Bacterial Infections ,Liver Failure, Acute ,Middle Aged ,medicine.disease ,Multiorgan failure ,Tissue Donors ,Liver Transplantation ,Surgery ,Survival Rate ,Treatment Outcome ,surgical procedures, operative ,Female ,Primary Graft Dysfunction ,business ,Program Evaluation - Abstract
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.
- Published
- 2011
30. Recurrence of primary sclerosing cholangitis after liver transplantation - The Hungarian experience
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Enikő Sárváry, György Gámán, László Kóbori, Dénes Görög, Zsuzsanna Gerlei, Balázs Nemes, Imre Fehérvári, Gergely Zádori, Fanni Gelley, and Peter Nagy
- Subjects
medicine.medical_specialty ,Original Paper ,Adult patients ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Whole liver ,Orvostudományok ,General Medicine ,Liver transplantation ,Klinikai orvostudományok ,medicine.disease ,Graft loss ,Inflammatory bowel disease ,Gastroenterology ,Surgery ,Primary sclerosing cholangitis ,Internal medicine ,medicine ,business ,Colectomy - Abstract
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.
- Published
- 2013
31. [Kidney function and liver transplantation]
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János Fazakas, Zsuzsa Gerlei, György Gámán, Balázs Nemes, László Kóbori, Gabriella Lengyel, Enikő Sárváry, Fanni Gelley, Gergely Zádori, Attila Doros, Dénes Görög, Imre Fehérvári, and Eszter Dabasi
- Subjects
Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Hepatorenal Syndrome ,Vena cava ,medicine.medical_treatment ,Hepatitis C virus ,Renal function ,Vena Cava, Inferior ,Liver transplantation ,medicine.disease_cause ,Kidney ,Gastroenterology ,Postoperative Complications ,Hepatorenal syndrome ,Risk Factors ,Internal medicine ,medicine ,Diabetes Mellitus ,Humans ,Precision Medicine ,Aged ,Retrospective Studies ,business.industry ,Immunosuppression ,General Medicine ,Hepatitis C ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Constriction ,Survival Analysis ,Liver Transplantation ,Immunology ,Preoperative Period ,Female ,business ,Immunosuppressive Agents - Abstract
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.
- Published
- 2013
32. MARS therapy, the bridging to liver retransplantation - Three cases from the Hungarian liver transplant program
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Eszter Dabasi, Tamás Mándli, Szabolcs Tóth, Gellért Tőzsér, Tamás Szabó, Balázs Nemes, László Kóbori, László Piros, Gyula Végső, Éva Toronyi, Dénes Görög, János Fazakas, Anikó Smudla, Attila Doros, Balázs Pőcze, and Gergely Zádori
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Fulminant ,Liver failure ,Case Report ,General Medicine ,Orvostudományok ,Liver transplantation ,medicine.disease ,Klinikai orvostudományok ,Extracorporeal ,Surgery ,Hepatorenal syndrome ,medicine ,Acute on chronic liver failure ,business ,Hepatic encephalopathy ,Cerebral herniation - Abstract
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.
- Published
- 2013
33. Biliary Complications After Orthotopic Liver Transplantation: The Hungarian Experience
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Dénes Görög, Fanni Gelley, Balázs Nemes, László Kóbori, Gergely Zádori, Imre Fehérvári, Attila Doros, and György Gámán
- Subjects
Graft Rejection ,medicine.medical_specialty ,Time Factors ,Necrosis ,medicine.medical_treatment ,Anastomotic Leak ,Arterial Occlusive Diseases ,Constriction, Pathologic ,Liver transplantation ,Klinikai orvostudományok ,Communicable Diseases ,Gastroenterology ,Lesion ,Hepatic Artery ,Cholestasis ,Risk Factors ,Internal medicine ,medicine ,Humans ,Retrospective Studies ,Hungary ,Transplantation ,Bile duct ,business.industry ,Incidence ,Cold Ischemia ,Graft Survival ,Thrombosis ,Retrospective cohort study ,Orvostudományok ,medicine.disease ,Liver Transplantation ,Surgery ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,Acute Disease ,medicine.symptom ,business - Abstract
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.
- Published
- 2013
34. Technical Risk Factors for Hepatic Artery Thrombosis After Orthotopic Liver Transplantation: the Hungarian Experience
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György Gámán, László Kóbori, Fanni Gelley, Balázs Nemes, Imre Fehérvári, Attila Doros, Dénes Görög, and Gergely Zádori
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Tissue and Organ Procurement ,medicine.medical_treatment ,Arterial Occlusive Diseases ,Anastomosis ,Liver transplantation ,Klinikai orvostudományok ,Young Adult ,Hepatic Artery ,Risk Factors ,parasitic diseases ,Medicine ,Humans ,Young adult ,Survival analysis ,Retrospective Studies ,Transplantation ,Hungary ,business.industry ,Incidence (epidemiology) ,Graft Survival ,Retrospective cohort study ,Thrombosis ,Orvostudományok ,Middle Aged ,medicine.disease ,Survival Analysis ,Surgery ,Liver Transplantation ,Treatment Outcome ,Female ,Clinical Competence ,Hepatectomy ,business - Abstract
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.
- Published
- 2013
35. Sex-dependent liver colonization of human melanoma in SCID mice?role of host defense mechanisms
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Gergely Zádori, Andrea Ladányi, Tamás Lőrincz, József Tímár, József Tóvári, Erzsébet Rásó, Anita Mohos, and Judit Dobos
- Subjects
Cytotoxicity, Immunologic ,Male ,Receptors, Steroid ,Cancer Research ,Kupffer Cells ,Cell ,Apoptosis ,G(M1) Ganglioside ,Mice, SCID ,Biology ,Klinikai orvostudományok ,Immunoenzyme Techniques ,Mice ,Liver Neoplasms, Experimental ,Sex Factors ,Mice, Inbred NOD ,Cell Adhesion ,Tumor Cells, Cultured ,medicine ,Animals ,Humans ,Gonadal Steroid Hormones ,Receptor ,Melanoma ,Cell Proliferation ,Cell growth ,Kupffer cell ,General Medicine ,Orvostudományok ,Flow Cytometry ,medicine.disease ,Killer Cells, Natural ,Mice, Inbred C57BL ,medicine.anatomical_structure ,Oncology ,Cell culture ,Immunology ,biology.protein ,Female ,Antibody ,Hormone - Abstract
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.
- Published
- 2013
36. Examination of claudin-1 expression in patients undergoing liver transplantation owing to hepatitis C virus cirrhosis
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Ákos P. Deák, Attila Doros, P. Törzsök, Fanni Gelley, Gergely Zádori, Z. Schaff, Pál Nagy, Eniko Sárváry, Balázs Nemes, and András Kiss
- Subjects
Liver Cirrhosis ,Male ,Pathology ,medicine.medical_specialty ,Cirrhosis ,Time Factors ,Hepacivirus ,medicine.medical_treatment ,Hepatitis C virus ,Biopsy ,Liver transplantation ,medicine.disease_cause ,Klinikai orvostudományok ,Antiviral Agents ,Virus ,Recurrence ,Claudin-1 ,medicine ,Humans ,RNA, Messenger ,Transplantation ,Hungary ,biology ,medicine.diagnostic_test ,business.industry ,Reverse Transcriptase Polymerase Chain Reaction ,Membrane Proteins ,Orvostudományok ,Hepatitis C, Chronic ,Middle Aged ,medicine.disease ,biology.organism_classification ,Immunohistochemistry ,Reverse transcriptase ,Liver Transplantation ,Treatment Outcome ,Liver ,Surgery ,Female ,business - Abstract
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).
- Published
- 2011
37. [New-onset diabetes mellitus and liver transplantation, with special consideration of recurrent hepatitis C]
- Author
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Balázs, Nemes, Fanni, Gelley, Gergely, Zádori, Katalin, Földes, Gábor, Firneisz, Dénes, Görög, Imre, Fehérvári, László, Kóbori, Zsuzsanna, Gerlei, János, Fazakas, Simon, Pápai, Attila, Doros, Péter, Nagy, Gabriella, Lengyel, Zsuzsa, Schaff, and Eniko, Sárváry
- Subjects
Adult ,Liver Cirrhosis ,Male ,Incidence ,Graft Survival ,Age Factors ,Middle Aged ,Hepatitis C ,Survival Analysis ,Liver Transplantation ,Sex Factors ,Recurrence ,Risk Factors ,Hyperglycemia ,Acute Disease ,Diabetes Mellitus ,Humans ,Female ,Obesity - Abstract
New-onset diabetes is a common complication after liver transplantation.We aimed to analyze the incidence and rate of known risk factors and the impact of new-onset diabetes mellitus on postoperative outcome.We retrospectively evaluated the files of 310 patients who underwent liver transplantation between 1995 and 2009. Definition of new-onset diabetes included: repeated fasting serum glucose6.8 mmol/l and/or sustained antidiabetic therapy that was present 3 months after transplantation.New-onset diabetes occurred in 63 patients (20%). Differences between the new-onset and the control group were the donor body mass index (24+/-3 vs. 22.4+/-3.6 kg/m 2 , p = 0.003), donor male gender (58% vs. 33%, p = 0.002), and recipient age (47.6+/-7.2 vs. 38.3+/-14.6 year, p0.001), body mass index (26.7+/-3.8 vs. 23.3+/-5.6 kg/m 2 , p0.001), male gender (60% vs. 44%, p = 0.031). The 66% of patients with new-onset diabetes were transplanted with cirrhosis caused by hepatitis C virus infection, while in the control group the rate was 23% (p0.001). Cumulative patient survival rates at 1, 3, 5 and 8 year were 95%, 90.6%, 88% and 88% in the control group, and 87%, 79%, 79% and 64% in the de novo group, respectively (p = 0.011). Cumulative graft survival rates at 1, 3, 5 and 8 year in the control group were 92%, 87%, 86% and 79%, in the de novo diabetes group the rates were 87%, 79%, 79%, 65%, respectively (p = NS). In case of early recurrence (in 6 months), majority of patients developed new-onset diabetes (74% vs. control 26%, p = 0.03). More patients had more than 10 times higher increase of the postoperative virus titer correlate to the preoperative titer in the de novo diabetes group (53% vs. 20%, p = 0.028). Mean fibrosis score was higher in new-onset group one year after the beginning of antiviral therapy (2.05+/-1.53 vs. 1.00+/-1.08, p = 0.039).Risk factors for new-onset diabetes after transplantation are older age, obesity, male gender and cirrhosis due to hepatitis C infection. The early recurrence, viremia and more severe fibrosis after antiviral therapy have an impact on the occurrence of new-onset diabetes in hepatitis C positive patients.
- Published
- 2010
38. [Biliary complications following orthotopic liver transplantation. The Hungarian experience]
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Imre Fehérvári, Zoltan Mathe, Dénes Görög, Katalin Jakab, Szabolcs Tóth, Eniko Sárváry, Andrea Dávid, Attila Doros, Andrea Németh, László Piros, Erika Hartmann, Jeno Járay, Gergely Zádori, János Fazakas, Balázs Nemes, and Zsuzsa Gerlei
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Orthotopic liver transplantation ,medicine.medical_treatment ,Biliary Tract Diseases ,Constriction, Pathologic ,Kaplan-Meier Estimate ,Liver transplantation ,Radiography, Interventional ,Gastroenterology ,Necrosis ,Biliary Atresia ,Ischemia ,Risk Factors ,Internal medicine ,medicine ,Bile ,Humans ,Biliary Tract ,Aged ,Retrospective Studies ,Hungary ,Cholestasis ,business.industry ,General Medicine ,Middle Aged ,Liver Transplantation ,Hepatic artery thrombosis ,Quality of Life ,Female ,business - Abstract
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.
- Published
- 2008
39. Predictive Factors of Sustained Virological Response for Recurrent Hepatitis C Virus After Liver Transplantation: The Hungarian Experience
- Author
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Balázs Nemes, Zsuzsanna Gerlei, Enikő Sárváry, András Kiss, Gabriella Lengyel, Fanni Gelley, Gergely Zádori, and Pál Nagy
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Hepatitis C virus ,Hepacivirus ,Liver transplantation ,Klinikai orvostudományok ,medicine.disease_cause ,Gastroenterology ,Virus ,History, 17th Century ,Virological response ,Recurrence ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Recurrent hepatitis ,Transplantation ,business.industry ,Standard treatment ,virus diseases ,Immunosuppression ,Orvostudományok ,medicine.disease ,digestive system diseases ,Liver Transplantation ,Surgery ,Female ,business ,Immunosuppressive Agents - Abstract
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).
- Published
- 2012
40. Relationship Between Hepatitis C Virus Recurrence and De Novo Diabetes After Liver Transplantation: The Hungarian Experience
- Author
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Eniko Sárváry, Imre Fehérvári, Balázs Nemes, Gábor Firneisz, János Fazakas, Zsuzsanna Gerlei, Gergely Zádori, László Wagner, Gabriella Lengyel, Fanni Gelley, and S. Papai
- Subjects
Liver Cirrhosis ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Hepatitis C virus ,Hepacivirus ,Population ,Liver transplantation ,Klinikai orvostudományok ,medicine.disease_cause ,Antiviral Agents ,Risk Assessment ,Gastroenterology ,Flaviviridae ,Recurrence ,Risk Factors ,Fibrosis ,Diabetes mellitus ,Internal medicine ,Diabetes Mellitus ,medicine ,Humans ,Hypoglycemic Agents ,Viremia ,education ,Retrospective Studies ,Hungary ,Transplantation ,education.field_of_study ,biology ,business.industry ,Orvostudományok ,biology.organism_classification ,medicine.disease ,Hepatitis C ,Liver Transplantation ,Surgery ,Survival Rate ,Treatment Outcome ,Complication ,business - Abstract
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.
- Published
- 2011
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