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Simple Summary: This study investigates the factors influencing the effectiveness of transarterial bleomycin–lipiodol embolization (TACE) in managing giant hepatic hemangiomas. Through a retrospective analysis of 31 adult patients, the research identifies key factors associated with successful volume reduction post-treatment, such as higher bleomycin doses and extended follow-up periods. Notably, the study found no significant correlation between lesion location or preoperative size and clinical success, highlighting that TACE remains effective across varied lesion sizes. These findings suggest potential for tailored dosing and timing strategies in clinical practice to optimize outcomes, while the study encourages further investigation into refining TACE protocols. Introduction: Giant hepatic hemangiomas are challenging to manage, requiring effective therapeutic approaches. Transarterial bleomycin–lipiodol embolization (TACE) has shown promise as a treatment option, yet predictive factors for its success are not well defined. This study aimed to assess the efficacy of TACE for giant hepatic hemangiomas and identify factors influencing treatment outcomes. Methods: A retrospective analysis of 31 adult patients who underwent TACE with bleomycin and lipiodol between December 2014 and October 2022 was conducted. Clinical parameters including age, sex, hemangioma location, lesion size, bleomycin dose, number of TACE sessions, and follow-up duration were evaluated. The primary outcome was hemangioma volume reduction, with statistical analyses identifying factors associated with significant lesion regression. Results: Higher bleomycin doses and longer intervals from procedure to follow-up were positively correlated with hemangioma volume reduction, while variables such as patient sex and lesion location showed no statistically significant impact on clinical success. The findings suggest that increased bleomycin dosage and extended follow-up periods may enhance treatment efficacy. Conclusions: The study identifies bleomycin dose and follow-up duration as predictive factors for TACE success in treating giant hepatic hemangiomas, underscoring their role in optimizing therapeutic strategies. These insights contribute to improved treatment personalization for patients with giant hepatic hemangiomas and highlight the need for further prospective studies to validate and expand upon these findings. [ABSTRACT FROM AUTHOR]

Background/Aim. Transcatheter arterial chemoembolization (TACE) and portal vein embolizations (PVE) are established methods of treatment of patients with hepatic tumors. The aim of the study was to present our experience in the treatment of liver tumors with embolization as a preliminary treatment for surgery or a part of palliative treatment. Methods. The analysis included 29 patients who had undergone 34 embolizations. Results. TACE was performed in 26 cases with hemangiomas in the unfavorable location, or mass effect and inoperable malignant tumors both primary and metastatic. PVE was performed in 8 cases with primary liver tumors and colon liver metastases.All included patients presented inoperable hepatic tumors. TACE was carried out in the patients with hepatocellular carcinoma (n = 1), cholangiocarcinoma (n = 1), metastatic tumor (n = 8), and hemangioma (n = 16), while PVE in the patients with cholangiocarcinoma (n = 2), metastatic tumor (n = 5) and neuroendocrine tumor (n = 1). The embolization was followed by surgery in the 5 PVE patients and 6 TACE patients. The postembolization syndrome was observed in 7 subjects. Death due to cancer progression occurred in the 4 PVE patients and 7 TACE patients. One patient died during TACE due to hemorrhagic shock. Conclusions. Right PVE and selective TACE are efficient for preliminary preparation of patients with healthy hepatic parenchyma for major liver resections, but the patients with liver cirrhosis require careful assessment. In the patients with hemangioma, embolization allows to avoid surgical treatment by reducing the lesion mass, or the extent of hepatic resection. The preliminary results of arterial embolizations with bleomycin, leading to tumor reduction in cases of giant liver hemangiomas are promising.

Introduction: Cancer of the gallbladder is a serious diagnostic and therapeutic problem. According to the literature, 30% of cases are not confirmed before surgery. Other cases are detected incidentally by histopathology. Clinical trials and meta-analyses show that incidental gallbladder cancer (iGBC) occurs in 0.19%-2.8% of patients after cholecystectomy. The aim of this study was to analyze the incidence and severity of iGBC in cholecystectomy procedures performed in the surgical department at the 4th Military Teaching Hospital in Wroclaw during the years 1990-2014. Patients and methods: In the years 1990-2014, a total of 7,314 cholecystectomies were performed in the surgical department because of cholecystolithiasis: 6,145 were performed using the laparoscopic approach (84.02%), 867 were performed as open surgery (11.8%), and 302 cases required conversion (5.1%). In this group, 5,214 of the patients were females (71.3%) and 2,100 were males (28.7%), with an average age of 54.7 years. Results: We found 64 iGBC cases which were confirmed by histopathology. This represented 0.87% of all cases. In this group, 50 patients were females (78.1%) and 14 were males (21.8%), with an average age of 67.1 years. Of this group, 40 patients underwent a classic cholecystectomy, while 24 underwent laparoscopic procedures, out of which 13 cases ultimately required traditional surgery. The histopathology showed 15 carcinomas that were classified as G1 (23.4%), 28 were G2 (43.75%), and 21 were G3 (32.8%). Conclusion: iGBC detected after a cholecystectomy due to cholecystolithiasis is a rare disease. We found iGBC in 0.87% of cases, which is on a comparable scale to the world literature. In the case of cancer, we frequently found it necessary to convert to an open surgical procedure. This cancer is more common in females and in people over 60 years of age. [ABSTRACT FROM AUTHOR]

Objectives. Presence of lymphatics in adventitia of major arteries remains controversial. Presence of lymphatics in adventitia of internal carotid artery was not documented and its relation to atherosclerosis was not studied. The aim of our study was to evaluate presence of lymphatic vessels in adventitia of internal carotid artery in healthy and atherosclerotic arteries. Methods. Fragments of arterial wall of internal carotid artery were obtained during the surgical eversion endarterectomy in 15 patients with internal carotid artery stenosis and 2 healthy organ donors. 21 arteries were studied. Patients age ranged from 56 to 77 years. Fragments of arterial wall were embeded in paraffin. Lymphatics of arterial adventitia were visualized with immunohistochemistry using LYVE-1 and anty-podoplanin antibodies. Results. The lymphatic vessels were visualized in adventitia of 20 carotid arteries. The serial sections have revealed that both LYVE-1 and podoplanin have identical specificity for lymphatic endothelium Number of lymphatics in adventitia significantly correlated with thickness of intima (p<0.046). Conclusions. Lymphatics are present in adventitia of internal carotid artery. Number of adventitial lymphatics increases with severity of atherosclerosis measured as intimal thickness. [ABSTRACT FROM AUTHOR]

Biliary cystadenomas (BCAs), rare cystic tumors occurring in the biliary system, account for fewer than 5% of cystic lesions in the liver. This case details successful resection in a 29-year-old pregnant woman at seven weeks gestation. Urgent left hemihepatectomy and cholecystectomy removed a mucinous hepatobiliary cystadenoma. Postoperatively, a healthy newborn was delivered by cesarean section. Five-year follow-up showed no recurrence. BCAs present diagnostic challenges due to nonspecific symptoms, and surgical intervention, preferably complete resection, is recommended for potential malignancy, after weighing benefits against complications in critical hepatic vessel lesions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Patrzałek et al.)

Unlabelled: Alloimune activation is one of the most significant post transplant events, which results in increased expression of costimulatory molecules. These molecules have been suggested to play a role in determining the outcome of immune response including graft rejection., Material and Methods: We examined the CD28 and both surface and intracellular CTLA-4 expression on freshly drawn and anti-CD3+rlL-2 stimulated peripheral blood CD4+ T cells in kidney transplant recipients with acute graft rejection and with non-complicated post transplant course. Dual immunofluorescence and flow cytometry methods were used. The proportion of freshly isolated CD4+/ CTLA4 was higher in both groups of graft recipients in comparison to healthy controls reflecting in vivo allostimulation., Results: We found the increased percentage of CD4+ cells expressing surface CTLA4 after stimulation, unstimulated intracellular CTLA4 and lower percentage of CD4+ cells expressing CD28 after stimulation in kidney recipients without rejection., Conclusions: Our results indicate the possible relationship between the expression pattern of CTLA4 inhibitory molecule on CD4+ cells and clinical course after renal transplantation.

Effector cells such as eosinophils and mononuclear cells play crucial role in the mechanism of injury during acute renal allograft rejection (ARAR). The aim of the study was to evaluate an influence of tissue eosinophilia observed in the renal allograft biopsy (RAB) during ARAR on rejection severity (reversibility) as well as long-term graft function. The histopathological examination and the quantitative assessment was performed in 165 RAB with symptoms of ARAR. The numbers of eosinophils were counted at high power (40xobj), over the entire renal cortex, minimum 10 high power fields(hpf). Results. Significant tissue eosinophilia was found in 49 RAB (29%). In the Eosinophilic Group (EG) we observed: more frequent biopsy-confirmed ARAR episodes (1.79 vs. 1.33/pts; p=0.03), higher grade of acute rejection according to the Banff classification (p=0.007), more severe clinical course of rejection expressed as worse graft function at 6 month after treatment (serum creatinine 2.2 vs. 1.5 mg/dl). Chronic rejection was seen in 25% pts of EG and in 11% pts of Control Group (CG) in the first year after Tx. Graft survival at 6 month in the EG was shorter then in the CG (91% vs 96.3%). Conclusions. Eosinophilic infiltration of RAB is a negative predictor, which can indicate more severe course of ARAR and increased resistance to an anti-rejection therapy. It can determine an appearance of chronic allograft dysfunction hazard.

Unlabelled: The aim of the study was to evaluate the effect of brain death, ischemia-reperfusion injury and alloreactivity of some cytokines on intragraft mRNA expression., Material and Methods: We have examined 49 needle core biopsies of kidney allografts from cadaveric donors. Samples were taken before harvesting, after cold ischemia and approximately after 20-30 minutes of reperfusion. We have also assessed 56 allograft biopsies taken after transplantation. Tubular and glomerular expression of IL-2, IL-6, IL-10, IFN-gamma, TGF-beta 1 and PDGF-B mRNA was assessed using semiquantitative evaluation of the RT-PCR in situ on paraffin tissue sections., Results: In all pre-procurement specimens high glomerular and tubular IL-2, IL-6, IL-10, TGF-beta 1, PDGF-B and IFN-gamma mRNA expression was detected. After reperfusion an increase of IL-2, IL-6, and IL-10 mRNA expression was observed in all specimens and was limited only to tubules. Biopsies samples with borderline changes exhibited the lowest levels of cytokine gene expression close to the intensity in control specimens. An intense, comparing to normal kidney, tubular and glomerular all examined cytokines gene expression was also noticed during acute rejection. No significant differences between acute cellular and vascular rejection were noticed. The mRNA expression of IFN-gamma and IL-2, IL-6, IL-10 in chronic rejection did not differ from acute rejection. The tubular expressions of mRNA for IL-6 and TGF-gamma 1 in biopsies with acute rejection obtained from patients treated with MMF were significantly lower than in biopsies obtained from patients treated with azathioprine.

Unlabelled: The aim of the study was to assess relationship between the pharmacokinetics of mycophenolic acid (MPA) and the risk of developing acute rejection within 6 months after renal transplantation., Material and Methods: MPA concentrations were measured using validated HPLC. Venous blood samples for assay of MPA plasma concentrations were evaluated before (trough level; C) and 40 minutes, 1, 2 and 4 hours after mycophenolate mofetil (MMF) oral administration. The study included adult kidney cadaveric graft recipients: 26 patients treated with CsA, MMF and prednisone. MPA AUC was determined using the linear trapezoidal rule. Statistical significance was assessed using ANOVA Statistica., Results: A total of 13 patients experienced biopsy proven rejection. Patients with acute rejection had lower GFR, lower serum albumin and were younger. There was statistically significant difference for MPA AUC(0-4), C40, C(max) between patients with acute rejection and patients with uneventful outcomes: mean MPA AUC(0-4): 11,4 +/- 7,23 microg x h/ml versus 34,0 26,8 microgxh/ml (p 0,01). Recipients with MPA AUC(0-4) <20 g x h/ml had a greater risk of acute rejection., Conclusions: MPA AUC(0-4) was a useful predictor of outcome in renal recipients within first 6 months after renal transplantation.

Aim of the Study: was to examine the influence of conversion from cyclosporine-based therapy to tacrolimus/mycophenolate mofetil (MMF) on renal graft survival in patients with refractory rejection and on the recurrence of rejection in patients converted at the time of the first episode of rejection., Patients and Methods: A total of 64 renal graft recipients were converted to tacrolimus/MMF: 30 patients (Group I) in whom acute allograft rejection was not resolved after anti-rejection therapy; 34 patients (Group II) with first acute rejection, in whom tacrolimus/MMF was an adjunctive therapy to corticosteroid treatment., Results: In Group I, ten patients failed to recover graft function. Another 10 patients lost their grafts within 2 years after conversion. Two-year graft survival was 30%. Gastro-intestinal complications or leucopenia necessitated immunosuppressants dose reduction or interruption in 50% of the patients. In Group II, recurrence of acute rejection episode occurred in 12% of patients. Ten patients (30%) developed chronic rejection within 2 years after conversion. One and two year kidney graft survival was 97% and 93.6% respectively., Conclusions: Conversion to tacrolimus/MMF in patients with refractory rejection improved or stabilized renal function, but this effect was short-lasting. Intolerance of immunosuppressive drugs contributed greatly to the treatment inefficacy. Conversion to tacrolimus/MMF during the first acute rejection resulted in low risk of recurrent rejection. Nevertheless, progression to chronic graft nephropathy was observed.

Introduction: The successful use of hepatocytes depends on a reliable demonstration of the functional and morphological integrity of isolated cells. Herein we investigated whether the isolation and cryopreservation of primary human hepatocytes can compromise cell viability and liver-specific characteristics., Material/methods: Hepatocytes were isolated from encapsulated human liver segments by a modified 2-step perfusion technique. Isolated cells were Percoll-purified, cryopreserved, and stored in liquid nitrogen for 1-12 months. For rapid assessment of fresh and cryopreserve/thawed hepatocyte yield and viability, the cells were stained with trypan blue or labeled with fluorochromes. For immunocytochemical analysis, the cells were labeled with monoclonal antibodies for the presence of the following antigens and chemokines: CD3, CD45Ro, CD45Ra, CD34, CD68, CD90, CD95, CD20, HLA-DR, Ki67, PCNA, Bcl-2, p53, CXCR3, CXCR4, and SDF-1. The cells were tested for several specific functions, such as ureagenesis, energy status, MTT activity, lactate dehydrogenase leakage, and total CYP450 content., Results: Assessment of both freshly isolated (Percoll-purified) and cryopreserved/thawed hepatocytes revealed a low constitutive level of contamination by non-parenchymal cells compared with crude (unpurified) preparations and tissue sections. All viable hepatocytes showed intact morphology and retained CYP450 protein, energy status, and urea synthesis., Conclusions: Modifications in hepatocyte preparations, such as depletion of dead, damaged, and nonparenchymal cells, improves cell purity, which can be adapted to further evaluation of hepatocyte immunogenicity. These data illustrate the importance and feasibility of human hepatocyte banking.

The authors present current status of liver transplantation (LTx) in Poland. Till 2004, 845 LTx were performed: 604 in adults and 241 in children; 71 of them were the living donor LTx. Post-inflammatory cirrhosis in adults and biliary atresia in children were the most common indications for LTx. The results of LTx in Poland are good and comparable with the results published by other centers. The number of available cadaveric grafts is growing and in 2004 achieved an index of harvesting as high as 14,7 per million people.

Unlabelled: There is growing experimental evidence that Chlamydia pneumoniae is a risk factor and contribute to the development of atherosclerosis of carotid artery. This process might cause stenosis of carotid artery and TIA or stroke., Aim: Aim of this study was to evaluate the frequency of Ch. pneumoniae infection in carotid artery stenosis patients and in control group-healthy artery from multiorgan donors., Material and Methods: From each of 84 patients undergoing carotid endarterectomy the samples were analyzed by nested PCR for Ch. pneumoniae DNA. Furthermore we determined DNA Ch. pneumoniae in carotid artery from 20 multiorgan donors., Results: In control group-healthy artery the PCR for Ch. pneumoniae was negative in all samples. Ch. pneumoniae was detected in 57 patients (67.85%) with symptomatic carotid artery stenosis, however in 27 patients (32.15%) the PCR test was negative., Conclusions: We did not observe infection of Ch. pneumoniae in healthy carotid artery-control group. We noted great frequency of infection in patients with stenosis of carotid artery. Patients with stenosis of carotid artery can be candidates to antibiotic therapy, which can slow down the progression of artery stenosis.

Aim: The purpose of this study is to evaluate the use of immunosuppression in treatment of prosthetic graft infections with arterial transplantation., Material and Methods: In this paper 29 cases of the massive aorto-ilio-femoral graft infection treated by the replacement of infected prosthesis with arterial homograft are presented. The arterial allograft was stored with application of cold ischemia method in preservation solution at 4 degrees C. During the follow up period the patients were divided into two groups: group received immunosuppressive regimen after surgery (n = 16) and group without immunosuppression (n = 13). The Duplex-Doppler ultrasound, the scintigraphy with use of Technetium-labeled leukocytes, bacteriological and antigenic examination and blood levels of Cyclosporin A were used in the diagnostic trial of infection and of the healing process of the homograft. In both groups there was performed evaluation of arterial wall by using the scanning electron microscopy., Results: In the group with immunosuppression no complications due to the homograft's wall degradation and deficiency of cell mediated immunity in infections were noticed. In the group without immunosuppression there were observed complications related to the impairment of the allograft wall: in 3 cases--the graft rupture, in 2 cases--the graft true aneurysm and homograft thrombosis in 3 cases., Conclusion: The use of immunosuppression in transplantation of artery produces increase in survival rate and improves function of arterial graft.

In this study a method of elimination of the second warm ischemia is shown. The method is based on the application of a specially constructed polyethylene bag, in which the transplanted kidney is placed in the time course from a removal from ice to the reconstruction of vessel flow. The bag is built of polyethylene foil HDPE of low density produced under high pressure. Own construction of the bag (three spaces and polyethylene) enables the storage of a transplanted organ at the stable temperature +4 Celsius degrees. Thanks to the separation of containers for melting ice and for the kidney, possible becomes unrestrained performance of both venous and arterial anastomosis independently of existing operative conditions. Due to the applied method of the elimination of the second warm ischemia with the usage of own construction of polyethylene bag HDPE, one can expect better early renal function after transplantation--decrease in the number of cases and shortening of the time of acute tubular necrosis (ATN--Acute Tubular Necrosis).

Transplantation of organs and tissues procured from brain-dead organ donor (BDOD) is nowadays a common and desirable therapy for end-stag organ failure, especially kidneys, liver and heart. The majority of organs for transplantation are obtained from individuals with massive and irreversible central nervous system injury. This group of organ donors is however unsatisfactory and small according to needs. Significant percentage of multiorgan donors could be found among patients suffering from primary cerebral neoplasms as these rarely metastasize spontaneously outside the central nervous system. The paper presents the case of a 30-year-old male donor with a central nervous system tumor. Histogenesis, pathway of malignant dissemination, prognosis and the use of organ donor with cerebellar medulloblastoma are also discussed.

The transmission of donor-related malignancies by organ transplantation is rare event but biological behaviour of malignant tumors developed by the transplanted patients is in general more aggressive than similar ones in non-transplanted population. This paper presents an analysis of our series of cases and a review of the literature to the point of the transmission of cancer from organ donors with primary central nervous system tumors. Patients with primary CNS neoplasms have been accepted for organ donation because these tumors very rarely spread outside the CNS. To our knowledge, after an extensive review of the literature, the CNS tumor transmission risk with transplantation may be estimated between a little more than 0% and 3%. In the light of available data and in accordance with our investigations we consider that patients with CNS tumors can be accepted as donors as long as the risk of dying on the waiting lists is significantly higher than the tumor transferral risk. Organ donors with benign or low-grade CNS tumor should be accepted unreservedly. Donors with high-grade tumors should be consider as "marginal donors" and their assessment can be based on the comparison and the balance between the risk of tumor transmission and the medical condition of the recipient.