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    Tytuł:
    Reoperacje z powodu krwawienia do jamy brzusznej po przeszczepieniu wątroby od dawcy zmarłego
    Autorzy:
    Figiel, Wojciech
    Grąt, Michał
    Wronka, Karolina
    Patkowski, Waldemar
    Krasnodębski, Maciej
    Masior, Łukasz
    Stypułkowski, Jan
    Grąt, Karolina
    Krawczyk, Marek
    Powiązania:
    https://bibliotekanauki.pl/articles/1393903.pdf
    Data publikacji:
    2016
    Wydawca:
    Index Copernicus International
    Tematy:
    transplantacja wątroby
    krwawienie
    reoperacja
    śmiertelność
    wyniki
    Opis:
    Krwawienie do jamy otrzewnej jest jednym z najczęstszych powikłań chirurgicznych po transplantacji wątroby. Celem pracy była analiza czynników ryzyka krwawienia do jamy otrzewnej po transplantacji wątroby wymagającego reoperacji oraz zbadanie znaczenia tego powikłania w kontekście wczesnych i odległych wyników przeszczepień. Materiał i metodyka. Dane 603 przeszczepień wątroby wykonanych w Klinice Chirurgii Ogólnej, Transplantacyjnej i Wątroby w okresie od stycznia 2011 do września 2014 r. poddano analizie retrospektywnej. Do punktów końcowych badania należały: reoperacja z powodu krwawienia oraz zgon w okresie do 90 dni i od 90 dni do 3 lat po transplantacji. Wyniki. Reoperacje z powodu krwawienia wewnątrzbrzusznego konieczne były po 45 z 603 (7,5%) transplantacji. Niższe stężenie hemoglobiny przed operacją było jedynym niezależnym predykatorem reoperacji (p=0,002), z wartością odcięcia wynoszącą 11,3 g/dl. Odsetek śmiertelności pooperacyjnej w grupie biorców poddanych relaparotomii z powodu krwawienia był istotnie wyższy (15,6% vs 5,6%, p=0,008) w porównaniu do pozostałych chorych. Przeżycie ogólne od 90 dni do 3 lat po transplantacji w grupie chorych poddanych relaparotomii z powodu krwawienia (83,3%) było nieistotnie niższe w porównaniu do pozostałych chorych (92,2%, p=0,096). Niezależnie jednak od gorszych obserwowanych wyników transplantacji, analizy wieloczynnikowe nie potwierdziły istotnego wpływu relaparotomii wykonywanych z powodu krwawienia do jamy brzusznej na wczesną śmiertelność pooperacyjną (p=0,589) oraz 3-letnie przeżycie chorych (p=0,079). Wnioski. Interwencje chirurgiczne z powodu krwawienia do jamy brzusznej nie wpływają obecnie negatywnie na wczesne i odległe wyniki transplantacji wątroby. Przedoperacyjne stężenie hemoglobiny powyżej 11,3 g/dl jest czynnikiem istotnie zmniejszającym ryzyko wystąpienia tego powikłania, jednak przydatność kliniczna tego parametru wydaje się być wątpliwa.
    Źródło:
    Polish Journal of Surgery; 2016, 88, 4; 196-201
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Reoperations for intraabdominal bleeding following deceased donor liver transplantatio
    Autorzy:
    Figiel, Wojciech
    Grąt, Michał
    Wronka, Karolina
    Patkowski, Waldemar
    Krasnodębski, Maciej
    Masior, Łukasz
    Stypułkowski, Jan
    Grąt, Karolina
    Krawczyk, Marek
    Powiązania:
    https://bibliotekanauki.pl/articles/1393849.pdf
    Data publikacji:
    2016
    Wydawca:
    Index Copernicus International
    Tematy:
    liver transplantation
    bleeding
    reoperation
    mortality
    outcomes
    Opis:
    Intraabdominal hemorrhage remains one of the most frequent surgical complications after liver transplantation. The aim of the study was to evaluate risk factors for intraabdominal bleeding requiring reoperation and to assess the relevance of the reoperations with respect to short- and long-term outcomes following liver transplantation. Material and methods. Data of 603 liver transplantations performed in the Department of General, Transplant and Liver Surgery in the period between January 2011 and September 2014 were analyzed retrospectively. Study end-points comprised: reoperation due to bleeding and death during the first 90 postoperative days and between 90 postoperative day and third post-transplant year. Results. Reoperations for intraabdominal bleeding were performed after 45 out of 603 (7.5%) transplantations. Low pre-transplant hemoglobin was the only independent predictor of reoperation (p=0.002) with the cut-off of 11.3 g/dl. Postoperative 90-day mortality was significantly higher in patients undergoing reoperation as compared to the remaining patients (15.6% vs 5.6%, p=0.008). Post-transplant survival from 90 days to 3 years was non-significantly lower in patients after reoperation for bleeding (83.3%) as compared to the remaining patients (92.2%, p=0.096). Nevertheless, multivariable analyses did not reveal any significant negative impact of reoperations for bleeding on short-term mortality (p=0.589) and 3-year survival (p=0.079). Conclusions. Surgical interventions due to postoperative intraabdominal hemorrhage do not appear to affect short- and long-term outcomes following liver transplantation. Preoperative hemoglobin concentration over 11.3 g/dl is associated with decreased risk of this complication, yet the clinical relevance of this phenomenon is doubtful.
    Źródło:
    Polish Journal of Surgery; 2016, 88, 4; 196-201
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Short and Long-Term Outcomes After Primary Liver Transplantation in Elderly Patients
    Autorzy:
    Grąt, Michał
    Kornasiewicz, Oskar
    Grąt, Karolina
    Antczak, Arkadiusz
    Ligocka, Joanna
    Hołówko, Wacław
    Wronka, Karolina Maria
    Kobryń, Konrad
    Skalski, Michał
    Pączek, Leszek
    Krawczyk, Marek
    Powiązania:
    https://bibliotekanauki.pl/articles/1396438.pdf
    Data publikacji:
    2013-10-01
    Wydawca:
    Index Copernicus International
    Tematy:
    liver transplantation
    outcomes
    elderly patients
    recipient age
    malignancies
    donor age
    Opis:
    The number of elderly patients undergoing liver transplantation (LT) is increasing worldwide. The aim of the study was to evaluate the impact of recipient age exceeding 60 years on early and long-term outcomes after LT. Material and methods. This study comprised data of 786 patients after primary LT performed at a single center between January 2005 and October 2012. Patients over and under 60 years of age were compared with respect to baseline characteristics and outcomes: postoperative mortality (90-day) and 5-year patient (PS) and graft (GS) survival. Associations between recipient age exceeding 60 years and LT results were assessed in multiple Cox regression models. Results. Recipients older than 60 years (n=107; 13.6%) were characterized by more frequent hepatitis C virus infections (p<0.001), malignancies (p<0.001), and cardiovascular comorbidities (p<0.001); less frequent primary sclerosing cholangitis (p=0.002) and Roux-en-Y hepaticojejunostomy (p<0.001); lower Model for End-stage Liver Disease (MELD; p=0.043); and increased donor age (p=0.012). Fiveyear PS of older and younger recipients was 72.7% and 80.6% (p=0.538), while the corresponding rates of GS were 70.3% and 77.5% (p=0.548), respectively. Recipient age exceeding 60 years was not significantly associated with postoperative mortality (p=0.215), PS (p=0.525) and GS (p=0.572) in multivariate analyses. The list of independent predictors comprised MELD (p<0.001) for postoperative mortality; malignancies (p=0.003) and MELD (p<0.001) for PS; and malignancies (p=0.003), MELD (p<0.001) and donor age (p=0.017) for GS. Conclusions. Despite major differences between elderly and young patients, chronological age exceeding 60 years alone should not be considered as a contraindication for LT.
    Źródło:
    Polish Journal of Surgery; 2013, 85, 10; 581-588
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Comparison of Total Tumor Volume, Size and Number of Colorectal Liver Metastases in Prediction of Survival in Patients after Liver Resection
    Autorzy:
    Hołówko, Wacław
    Grąt, Michał
    Wronka, Karolina Maria
    Stypułkowski, Jan
    Roszkowski, Rafał
    Studnicki, Paweł
    Krawczyk, Marek
    Powiązania:
    https://bibliotekanauki.pl/articles/1395543.pdf
    Data publikacji:
    2015-02-01
    Wydawca:
    Index Copernicus International
    Tematy:
    colorectal liver metastases
    liver resection
    total tumor volume
    Opis:
    Liver is the most common location of the colorectal cancer metastases occurrence. Liver resection is the only curative method of treatment. Unfortunately it is feasible only in 25% of patients with colorectal liver metastases, often because of the extensiveness of the disease. The aim of the study was to evaluate the predictive value of total tumor volume, size and number of colorectal liver metastases in patients treated with right hemihepatectomy. Material and methods. A retrospective analysis was performed in a group of 135 patients with colorectal liver metastases, who were treated with right hemihepatectomy. Total tumor volume was estimated based on the formula (4/3)πr3. Moreover, the study included an analysis of data on the number and size of tumors, radicality of the resection, time between primary tumor resection and liver resection, pre-operative blood serum concentration of carcinoembryonal antigen (CEA) and carcinoma antigen Ca19-9. The predictive value of the factors was evaluated by applying a Cox proportional hazards model and the area under the ROC curve. Results. The univariate analysis has shown the predictive value of size of the largest tumor (p=0.033; HR=1.065 per each cm) on the overall survival, however no predictive value of number of tumors (p=0.997; HR=1.000) and total tumor volume (p=0.212; HR=1.002) was observed. The multivariate analysis did not confirm the predictive value of the size of the largest tumor (p=0.141; HR=1.056). In the analysis of ROC curves, AUROC for the total tumor volume, the size of the largest tumor and the number of tumors were 0.629, 0.608, 0.520, respectively. Conclusions. Total tumor volume, size and number of liver metastases are not independent risk factors for the worse overall survival of patients with colorectal liver metastases treated with liver resection, therefore increased values of these factors should not be a contraindication for surgical treatment
    Źródło:
    Polish Journal of Surgery; 2015, 87, 2; 53-58
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Prediction of Survival in Patients with Unresectable Colorectal Liver Metastases
    Autorzy:
    Hołówko, Wacław
    Grąt, Michał
    Hinderer, Barbara
    Orlińska, Izabela
    Krawczyk, Marek
    Powiązania:
    https://bibliotekanauki.pl/articles/1395796.pdf
    Data publikacji:
    2014-07-01
    Wydawca:
    Index Copernicus International
    Tematy:
    colorectal cancer
    liver metastases
    unresectable metastases
    survival prediction
    Opis:
    Liver metastases are diagnosed synchronously with the primary tumour in 25% of patients with colorectal cancer. A half of the remaining patients develop liver metastases within 3 years following colectomy. At present, the only radical treatment of metastases is liver resection. Only 2.6% of patients survive 3 years if such treatment is not implemented. The aim of the study was to assess predictive factors of long-term survival in the group of patients with unresectable colorectal liver metastases carcinoma. Material and methods. Of 1029 patients with colorectal liver metastases, who were treated in the Department of General, Transplant and Liver Surgery of the Medical University of Warsaw in the years 2006-2012, cases of liver metastases assessed intraoperatively as unresectable were selected. The retrospective analysis included 85 patients. Based on the medical documentation, information concerning age, sex, characteristics of primary and secondary tumours, reasons for unresectability, neoadjuvant chemotherapy as well as local treatment of liver tumours was collected. Preoperative serum concentrations of CEA and CA 19-9 markers were considered. The Cox regression model, Kaplan- Meier estimator and log-rank test were applied in the statistical analyses. Results. The most common reason for unresectability were: number of metastases in 31 patients (36.5%) and extrahepatic metastases in 19 cases (22.4%). Overall survival in the entire group was 56.1% and 15.5% after 1 and 3 years respectively. A single-factor analysis showed that CEA serum levels (p=0.032; HR=1.002 per increase by 1 ng/ml) and the presence of extrahepatic metastases (p=0.037; HR=2.06) were predictors of worse survival. In a multivariate analysis, CEA concentration (p=0.017; HR=1.002 per increase by 1 ng/ml) was an independent predictor of death whereas the presence of extrahepatic metastases were not statistically significant (p=0.059; HR=2.09). Conclusions. Serum concentration of CEA marker is an independent predictor of worse survival, but the presence of extrahepatic metastases shows a similar tendency
    Źródło:
    Polish Journal of Surgery; 2014, 86, 7; 319-324
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    1000 Liver Transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw - Analysis of Indications and Results
    Autorzy:
    Krawczyk, Marek
    Grąt, Michał
    Barski, Krzysztof
    Ligocka, Joanna
    Antczak, Arkadiusz
    Kornasiewicz, Oskar
    Skalski, Michał
    Patkowski, Waldemar
    Nyckowski, Paweł
    Zieniewicz, Krzysztof
    Grzelak, Ireneusz
    Pawlak, Jacek
    Alsharabi, Abdulsalam
    Wróblewski, Tadeusz
    Paluszkiewicz, Rafał
    Najnigier, Bogusław
    Dudek, Krzysztof
    Remiszewski, Piotr
    Smoter, Piotr
    Grodzicki, Mariusz
    Korba, Michał
    Kotulski, Marcin
    Cieślak, Bartosz
    Kalinowski, Piotr
    Gierej, Piotr
    Frączek, Mariusz
    Rdzanek, Łukasz
    Stankiewicz, Rafał
    Kobryń, Konrad
    Nazarewski, Łukasz
    Leonowicz, Dorota
    Urban-Lechowicz, Magdalena
    Skwarek, Anna
    Giercuszkiewicz, Dorota
    Paczkowska, Agata
    Piwowarska, Jolanta
    Gelo, Remigiusz
    Andruszkiewicz, Paweł
    Brudkowska, Anna
    Andrzejewska, Renata
    Niewiński, Grzegorz
    Kilińska, Beata
    Zarzycka, Aleksandra
    Nowak, Robert
    Kosiński, Cezary
    Korta, Teresa
    Ołdakowska-Jedynak, Urszula
    Sańko-Resmer, Joanna
    Foroncewicz, Bartosz
    Ziółkowski, Jacek
    Mucha, Krzysztof
    Senatorski, Grzegorz
    Pączek, Leszek
    Habior, Andrzej
    Lechowicz, Robert
    Polański, Sławomir
    Leowska, Elżbieta
    Pacho, Ryszard
    Andrzejewska, Małgorzata
    Rowiński, Olgierd
    Kozieł, Sławomir
    Żurakowski, Jerzy
    Ziarkiewicz-Wróblewska, Bogna
    Górnicka, Barbara
    Hevelke, Piotr
    Michałowicz, Bogdan
    Karwowski, Andrzej
    Szczerbań, Jerzy
    Powiązania:
    https://bibliotekanauki.pl/articles/1396689.pdf
    Data publikacji:
    2012-06-01
    Wydawca:
    Index Copernicus International
    Tematy:
    liver transplantation
    indications
    results
    mortality
    Opis:
    The aim of the study was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw.Material and methods. Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival.Results. The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations.Conclusions. Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.
    Źródło:
    Polish Journal of Surgery; 2012, 84, 6; 304-312
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
    Tytuł:
    Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw
    Autorzy:
    Krawczyk, Marek
    Grąt, Michał
    Grąt, Karolina
    Wronka, Karolina
    Krasnodębski, Maciej
    Stypułkowski, Jan
    Masior, Łukasz
    Hołówko, Wacław
    Ligocka, Joanna
    Nyckowski, Paweł
    Wróblewski, Tadeusz
    Paluszkiewicz, Rafał
    Patkowski, Waldemar
    Zieniewicz, Krzysztof
    Pączek, Leszek
    Milkiewicz, Piotr
    Ołdakowska-Jedynak, Urszula
    Najnigier, Bogusław
    Dudek, Krzysztof
    Remiszewski, Piotr
    Grzelak, Ireneusz
    Kornasiewicz, Oskar
    Kotulski, Marcin
    Smoter, Piotr
    Grodzicki, Mariusz
    Korba, Michał
    Kalinowski, Piotr
    Skalski, Michał
    Zając, Krzysztof
    Stankiewicz, Rafał
    Przybysz, Marta
    Cieślak, Bartosz
    Nazarewski, Łukasz
    Nowosad, Małgorzata
    Kobryń, Konrad
    Wasilewicz, Michał
    Raszeja-Wyszomirska, Joanna
    Piwowarska, Jolanta
    Giercuszkiewicz, Dorota
    Sańko-Resmer, Joanna
    Rejowski, Sławomir
    Szydłowska-Jakimiuk, Monika
    Górnicka, Barbara
    Wróblewska-Ziarkiewicz, Bogna
    Mazurkiewicz, Michał
    Niewiński, Grzegorz
    Pawlak, Jacek
    Pacho, Ryszard
    Powiązania:
    https://bibliotekanauki.pl/articles/1395614.pdf
    Data publikacji:
    2015-05-01
    Wydawca:
    Index Copernicus International
    Tematy:
    liver transplantation
    survival
    outcomes
    donors
    center experience
    center volume
    Opis:
    Liver transplantation is a well-established treatment of patients with end-stage liver disease and selected liver tumors. Remarkable progress has been made over the last years concerning nearly all of its aspects. The aim of this study was to evaluate the evolution of long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw). Material and methods. Data of 1500 liver transplantations performed between 1989 and 2014 were retrospectively analyzed. Transplantations were divided into 3 groups: group 1 including first 500 operations, group 2 including subsequent 500, and group 3 comprising the most recent 500. Five year overall and graft survival were set as outcome measures. Results. Increased number of transplantations performed at the site was associated with increased age of the recipients (p<0.001) and donors (p<0.001), increased rate of male recipients (p<0.001), and increased rate of piggyback operations (p<0.001), and decreased MELD (p<0.001), as well as decreased blood (p=0.006) and plasma (p<0.001) transfusions. Overall survival was 71.6% at 5 years in group 1, 74.5% at 5 years in group 2, and 85% at 2.9 years in group 3 (p=0.008). Improvement of overall survival was particularly observed for primary transplantations (p=0.004). Increased graft survival rates did not reach the level of significance (p=0.136). Conclusions. Long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery are comparable to those achieved in the largest transplant centers worldwide and are continuously improving despite increasing recipient age and wider utilization of organs procured from older donors.
    Źródło:
    Polish Journal of Surgery; 2015, 87, 5; 221-230
    0032-373X
    2299-2847
    Pojawia się w:
    Polish Journal of Surgery
    Dostawca treści:
    Biblioteka Nauki
    Artykuł
      Wyświetlanie 1-8 z 8

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