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Influence of donor age on liver transplantation outcomes: A multivariate analysis and comparative study

World Journal of Gastrointestinal Surgery 2024年第2期16卷 331-344页

作者： Miran Bezjak Ivan Stresec br.nislav kocman Stipislav Jadrijević Tajana Filipec Kanizaj Miro Antonijević Bojana Dalbelo Bašić Danko Mikulić Department of Surgery University Hospital MerkurZagreb 10000Croatia Department of Electronics MicroelectronicsComputer and Intelligent SystemsFaculty of Electrical Engineering and ComputingZagreb 10000Croatia Department of Gastroenterology University Hospital MerkurZagreb 10000Croatia Development of Software Nanobit Ltd.Zagreb 10000Croatia

BACKGROUND The growing disparity between the rising demand for liver transplantation(LT)and the limited availability of donor organs has prompted a greater reliance on older liver ***,utilizing livers from elderly donors has been associated with outcomes inferior to those achieved with grafts from younger *** accounting for additional risk factors,we hypothesize that the utili-zation of older liver grafts has a relatively minor impact on both patient survival and graft *** To evaluate the impact of donor age on LT outcomes using multivariate analysis and comparing young and elderly donor *** In the period from April 2013 to December 2018,656 adult liver transplants were performed at the University Hospital *** multivariate Cox propor-tional hazards models were developed to independently assess the significance of donor *** age was treated as a continuous *** approach involved univariate and multivariate analysis,including variable selection and assessment of interactions and ***,to exemplify the similarity of using young and old donor liver grafts,the group of 87 recipients of elderly donor liver grafts(≥75 years)was compared to a group of 124 recipients of young liver grafts(≤45 years)from the *** rates of the two groups were estimated using the Kaplan-Meier method and the log-rank test was used to test the differences between *** Using multivariate Cox analysis,we found no statistical significance in the role of donor age within the constructed *** when retained during the entire model development,the donor age's impact on survival remained insignificant and transformations and interactions yielded no substantial effects on *** insigni-ficance and low coefficient values suggest that donor age does not impact patient survival in our ***,there was no statistical evidence that the five developed models did not adhe

关键词： Liver transplantation Elderly donors Survival analysis Postoperative complications Cox proportional hazard models

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Role of total pancreatectomy in the treatment of paraduodenal pancreatitis:A case report

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World Journal of Gastrointestinal Surgery 2019年第6期11卷 296-302页

作者： Danko Mikulic Tomislav Bubalo Anna Mrzljak Anita Skrtic Stipislav Jadrijevic Tajana Filipec Kanizaj br.nislav kocman Division of Abdominal Surgery and Organ Transplantation Department of Surgery University Hospital Merkur Division of Gastroenterology Department of Internal Medicine University of Zagreb School of Medicine University Hospital Merkur Department of Pathology and Cytology University of Zagreb School of Medicine University Hospital Merkur

BACKGROUND Paraduodenal pancreatitis(PP)is a rare form of chronic pancreatitis presenting with symptoms of duodenal *** treatment is often unsuccessful and pancreaticoduodenectomy is the preferred surgical approach.A mini review of the outcomes of surgical therapy for PP shows that the results of pancreaticoduodenectomy are predominantly *** SUMMARY In our case report of PP,we describe an unusual course first presenting with the symptoms of chronic pancreatitis and a pseudocyst of the pancreatic tail.A pseudocystojejunostomy was performed and the late postoperative course was complicated with the symptoms of duodenal *** laparotomy,PP was found and the patient was treated with a total *** postoperative course was uneventful and good weight gain with resolution of pain was demonstrated at follow up *** Surgery is currently the optimal treatment option for *** is also the best diagnostic tool in distinguishing between pancreatitis and pancreatic adenocarcinoma.

关键词： Paraduodenal pancreatitis Groove pancreatitis Chronic pancreatitis Total pancreatectomy Case report

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Liver re-transplantation for donor-derived neuroendocrine tumor: A case report

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World Journal of Clinical Cases 2019年第18期7卷 2794-2801页

作者： Anna Mrzljak br.nislav kocman Anita Skrtic Ivana Furac Jelena Popic Lucija Franusic Renata Zunec Davor Mayer Danko Mikulic Department of Medicine Merkur University HospitalSchool of MedicineUniversity of ZagrebZagreb 10000Croatia Department of Surgery Merkur University HospitalZagreb 10000Croatia Department of Pathology and Cytology Merkur University HospitalSchool of MedicineUniversity of ZagrebZagreb 10000Croatia DNA Laboratory Institute of Forensic Medicine and CriminalisticsSchool of MedicineUniversity of ZagrebZagreb 10000Croatia Department of Radiology Merkur University HospitalSchool of MedicineUniversity of ZagrebZagreb 10000Croatia School of Medicine University of ZagrebZagreb 10000Croatia Department for Tissue Typing Clinical Hospital Centre ZagrebZagreb 10000Croatia Institute of Forensic Medicine and Criminalistics School of MedicineUniversity of ZagrebZagreb 10000Croatia

BACKGROUND Donor-origin cancer is a well-recognized but rare complication after liver transplantation (LT). The rise in the use of extended criteria donors due to the current shortage of organs increases the risk. Data on donor-origin neuroendocrine neoplasms (NENs) and the most appropriate treatment are scarce. Here, we report a case of a patient who developed a NEN confined to the liver after LT and was treated with liver re-transplantation (re-LT). CASE SUMMARY A 49-year-old man with no other medical co-morbidities underwent LT in 2013 for alcoholic liver cirrhosis. The donor was a 73-year-old female with no known malignancies. Early after LT, a hypoechogenic (15 mm) lesion was detected in the left hepatic lobe on abdominal ultrasound. The lesion was stable for next 11 mo, when abdominal magnetic resonance identified two hypovascular lesions (20 and 11 mm) with atypical enhancement pattern. Follow-up abdominal ultrasound revealed no new lesions for the next 2.5 years, when magnetic resonance showed a progression in size and number of lesions, also confirmed by abdominal computed tomography. Liver biopsy proved a well-differentiated NEN. Genetic analysis of the NEN confirmed donor origin of the neoplasm. As NEN was confined to liver graft only, in 2018, the patient underwent his second LT. At 12 mo after re-LT the patient is well with no signs of NEN dissemination. CONCLUSION The benefits of graft explantation should be weighed against the risks of re-LT and the likelihood of NEN dissemination beyond the graft.

关键词： Donor-origin tumor Neuroendocrine tumor Liver transplantation Donor Case report

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Pre-and intraoperative predictors of acute kidney injury after liver transplantation

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World Journal of Clinical Cases 2020年第18期8卷 4034-4042页

作者： Anna Mrzljak Lucija Franusic Jadranka Pavicic-Saric Tomislav Kelava Zeljka Jurekovic br.nislav kocman Danko Mikulic Ivan Budimir-Bekan Mladen Knotek Department of Medicine Merkur University HospitalSchool of MedicineUniversity of ZagrebZagreb 10000Croatia General Hospital Dubrovnik Dubrovnik 20000Croatia Department of Anesthesiology and Intensive Medicine Merkur University HospitalSchool of MedicineUniversity of ZagrebZagreb 10000Croatia Laboratory for Molecular Immunology Croatian Institute for Brain ResearchUniversity of ZagrebSchool of MedicineZagreb 10000Croatia Department of Medicine Merkur University HospitalZagreb 10000Croatia Department of Surgery Merkur University HospitalZagreb 10000Croatia

BACKGROUND Acute kidney injury(AKI)after liver transplantation(LT)is a frequent and multifactorial event related to increased morbidity and *** factors for AKI after LT still need to be *** To identify the predictors of acute kidney injury after liver *** The frequency and pre-and intraoperative predictors of AKI within the first 7 d after LT were evaluated in adult liver transplant candidates in a single LT center in *** was defined according to the Kidney Disease:Improving Global Outcomes *** Out of 205 patients(mean age 57±10 years;73.7%males,52.7%with alcoholrelated liver disease)93(45.36%)developed AKI,and the majority of them(58.06%)had stage *** 5.38%of patients required renal replacement therapy after *** majority of patients(82.8%)developed AKI within the first two days after the *** logistic regression identified pre-LT body mass index(OR=1.1,95%CI:1.05-1.24)and red blood cell transfusion(OR=1.66,95%CI:1.09-2.53)as independent predictors of early post-LT AKI occurrence.30-d survival after LT was significantly better for patients without AKI(P=0.01).CONCLUSION Early AKI after LT is a frequent event that negatively impacts short-term *** pathogenesis of AKI is multifactorial,but pre-LT BMI and intraoperative volume shifts are major contributors.

关键词： Acute kidney injury Liver transplant Body mass index Red blood cell Survival

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Constrictive pericarditis as a cause of refractory ascites after liver transplantation:A case report

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World Journal of Clinical Cases 2019年第20期7卷 3266-3270页

作者： Miran Bezjak br.nislav kocman Stipislav Jadrijevic Hrvoje Gasparovic Anna Mrzljak Tajana Filipec Kanizaj Darko Vujanic Tomislav Bubalo Danko Mikulic Division of Abdominal Surgery and Organ Transplantation Department of SurgeryUniversity Hospital MerkurZagreb 10000Croatia Division of Cardiology Department of Internal MedicineUniversity Hospital Centre ZagrebZagreb 10000Croatia Division of Gastroenterology Department of Internal MedicineUniversity Hospital MerkurZagreb 10000Croatia Division of Cardiology Department of Internal MedicineUniversity Hospital MerkurZagreb 10000Croatia

BACKGROUND Refractory ascites is a rare complication following orthotopic liver transplantation(OLT).The broad spectrum of differential diagnosis often leads to delay in *** depends on recognition and treatment of the underlying *** pericarditis is a condition characterized by clinical signs of right-sided heart *** the advanced stages of the disease,hepatic congestion leads to formation of *** patients after OLT,cardiac etiology of ascites is easily overlooked and it requires a high degree of clinical *** SUMMARY We report a case of a 55-year-old man who presented with a refractory ascites three months after liver transplantation for alcoholic *** to transplantation the patient had a minimal amount of *** transplant procedure and the early postoperative course were *** posttransplant work up failed to reveal any typical cause of refractory post-transplant *** function of the graft was *** from atrial fibrillation,cardiac status was *** months post transplantation the patient developed dyspnea and severe fatigue with peripheral *** was still *** presenting signs of right-sided heart failure were highly suggestive of cardiac *** paracentesis was suggestive of cardiac ascites,and further cardiac evaluation showed typical signs of constrictive *** was performed followed by complete resolution of *** the follow-up the patient remained symptom-free with no signs of recurrent ascites and with normal function of the liver *** Refractory ascites following liver transplantation is a rare complication with many possible *** differential diagnosis needs to be considered.

关键词： Constrictive pericarditis Liver transplantation Refractory ascites Case report

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Effective Laparoscopic Catheter Insertion Technique for Peritoneal Dialysis Using Specially Designed Trocar:22 Years Multi-Center Retrospective Study of 804 Patients

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Surgical Science 2018年第4期9卷 135-147页

作者： Zoran Cala Ivo Soldo Zdravko Perko Nikola Knezevic Ivica kocman Vinko Alfier Miodrag Gudelj Andelko Koprek Mario Kordic Edo Matosevic Irena Senecic-Cala Jasenka Kraljevic Tadeja Pintar Department of Surgery General Hospital OgulinOgulinCroatia Department of Surgery University Hospital Sveti DuhZagrebCroatia Department of Surgery University Hospital SplitSplitCroatia Department of Urology University Hospital Center ZagrebZagrebCroatia University Hospital Merkur ZagrebCroatia Department of Surgery General Hospital SibenikSibenikCroatia Department of Surgery University Hospital RijekaRijekaCroatia Department of Surgery General Hospital VarazdinVarazdinCroatia Department of Urology University Hospital MostarMostarBosnia and Herzegovina Department of Surgery General Hospital PulaPulaCroatia Department of Pediatrics University Hospital Center ZagrebZagrebCroatia University Medical Center Ljubljana LjubljanaSlovenia

Introduction: Literature reveals several peritoneal dialysis laparoscopic catheter insertion techniques developed to improve long-term results for treatment chronic kidney failure with the technic of peritoneal dialysis. The purpose of the study is evaluation of developed and recommended minimally invasive laparoscopic technic for chronic peritoneal dialysis catheter placement using specially constructed trocar. Materials and Methods: Retrospective study included 804 patients in 10 departments of surgery. Surgical and non surgical complications related to PD catheter placement were analysed: bleeding, dialysate leak, early SSI, peritonitis, catheter tip migration, catheter obstruction, omental wrapping and visceral perforations. Available software (Microsoft? Excel for Windows 10, MedCalc, Mariakerke, Belgium) was used for statistical analysis (presented as percentages, mean ± SD or median). Conclusions: The presented technique with specially constructed trocar is a simple and effective procedure with fewer complications comparing to literature. The advantages of this method include long rectus sheath tunnel with the deep cuff placed pre-peritoneally, the small size of the entrance into the peritoneum and accurate position and control of catheter tip in the pelvis.

关键词： Minimally Invasive Surgical Technic Laparoscopic Catheter Insertion Peritoneal Dialysis Peritoneal Catheter Trocar For Laparoscopic Catheter Insertion

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