First experience in transplantation in one center Methods: Critical epidemiological condition that has developed in Republic of Moldova due to prevalence and incidence of viral cirrhosis, and as a result high mortality rate caused by liver cirrhosis-76.46 per 100000 of population (first place in the world). This fact required us to launch the program of liver transplantation. The first liver transplantation in Republic of Moldova was performed on February 22nd, 2013. This surgical intervention was successful for the donor and recipient. The first liver transplant from the death brain donor was performed after one year, and it was successful for the recipient. Up to now, 12 liver transplantations have been performed in our country, 7 of them from living donors and 5 from death brain donors. The etiology of transplantated recipients was: HBV-2 cases, HBV+HDV-4 cases, HBV+HCV-2 cases, HBV + HDV+ hepatocellular carcinoma-1 case, HBV+ hepatocellular carcinoma-1 case, primitive biliary cirrhosis-1 case and 1 case of retransplantat. Results: Complications after liver transplantation were following: postoperative bleeding-1 case, thrombosis of hepatic artery-1 case, biliary peritonitis-1 case, acute rejection of graft-1 case and convulsive syndrome-1 case. The mortality in the early postoperative period was in 2 cases, mortality during the first year was 0. Causes of mortality were-postoperative intra-cerebral bleeding and acute rejection of the graft. In the postoperative period, living donors didn't have any complications. Average length of stay in case of living donor liver transplantation was 43 days and in death brain liver transplantation was 32 days. Conclusions: Necessary number of 40 liver transplants every year will be reached due to implementation of national program of transplant in Republic of Moldova.

Ever since the first liver transplant in the Republic of Moldova in 2013 we have performed 30 liver transplantations, the first having been performed in collaboration with the surgical team from Romania, led by Professor Irinel Popescu. The serious deficit of available cadaveric organs has forced us to begin with right hemi-liver transplantation from a living donor. In one third of liver transplantations we used right hemi-liver graft from a living donor, and in 2/3 of cases whole liver graft was harvested from brain-dead donors. The indication for surgical intervention in most cases was hepatic cirrhosis of viral aetiology in terminal stages, three cases of hepatocellular carcinoma, and one case for each of primary biliary cirrhosis, drug-induced toxic hepatitis, and liver retransplantation caused by hepatic arterial thrombosis. 10 cadaveric grafts were harvested from elderly donors ( 65 years). In the early postoperative period, four recipients died (2 live donor graft recipients and 2 graft recipients from donors with brain death). Causes of death were: intracerebral haemorrhage in the early postoperative period - 1, acute graft rejection - 1, hepatic artery thrombosis - 1, primary graft dysfunction - 1. There were no deaths during the late postoperative period. Of the complications that occurred during the early postoperative period we can highlight acute graft rejection -2, hepatic arterial thrombosis - 1, intraabdominal postoperative haemorrhage - 1, hepatic artery thrombosis -1, biliary peritonitis - 1, primary graft dysfunction -1, seizures -1. Complications during the postoperative period: biliary peritonitis after choledochal drainage removal - 1, "small-for-size" - 2. The accumulated experience and the use of modern technologies has allowed us to reduce the postoperative mortality rate, as well as the rate of occurring complications, in order to transfer this surgical intervention from the category of exclusivity operations to the category of daily interventions.

Gallstone disease is the most common gastrointestinal disorder. The best epidemiological screening method to accurately determine the prevalence of gallstone disease is ultrasonography. Gallstone disease is considered a surgical disease since only cholecystectomy is capable of definitively curing the disease. Cholecystectomy is a limited indicator for the prevalence of gallbladder stones, as the perceived threshold for surgery and patient access to care differ markedly. Most patients with gallstones are asymptomatic and the risk of developing symptoms or complications related to gallstones is approximately 1-4% per year. The common complications of gallstones include biliary colic, acute cholecystitis, common bile duct stones, and gallstone pancreatitis. Although this disease has a low mortality rate, its economic and health impact is significant due to its high morbidity. Many risk factors for gallstone formation are not modifiable such as ethnic background, increasing age, female gender and family history or genetics. Conversely, the modifiable risks for gallstones are obesity, rapid weight loss and a sedentary lifestyle. The recognized risk factors of gallbladder stones for females cannot be extrapolated to men, and this demonstrates the polymorphic character of the etiopathogeny of cholelithiasis and requires further specification. Therefore, there is need for more knowledge of the epidemiological characteristics of gallstone disease in order to better identify therapeutic strategies. Journal of Surgery[Jurnalul de Chirurgie] J o ur nal of S u r g e ry [Jurna lu l d e Ch irurg ie ]

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