Liver transplantation in the republic of moldova. First experience

Abstract

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.

Cholelithiasis - Epidemiology, Risk Factors and Etiopathogenic Aspects: Up-to-Date

“…La prima vedere aparent simplă, diagnosticarea ecografică a LV nu impune dificultăți deosebite [11][12][13], pe când precizarea factorilor etiopatogenetici [14,15] cu specificarea funcționalității organelor racordate arborelui biliar (ficat, pancreas, duoden) necesită deja o abordare mult mai complexă și nici pe de parte facilă [16]. În astfel de circumstanțe se impun metode speciale de cercetare, anumite tehnici de ultimă oră fiind actualmente prohibitive pentru majoritatea pacienților sau clinicilor [17,18].…”

“…Această schimbare a fost determinată de abordul mai puțin invaziv, mai acceptabil sub aspect cosmetic, oferind în același timp un risc chirurgical mai mic comparativ cu procedeul chirurgical "deschis" [9,21]. Colecistectomie laparoscopică este în prezent cea mai frecventă operaţie electivă abdominală [2,5,6,13,16].…”

Endogenous hepatic toxicity and oxidative stress in the complications of gallstones associated with cholestatic jaundice

“…According to existing data in the literature, the presence of cholestatic jaundice in the complications of gallstones is reported in 10-20% of cases, with choledocholithiasis as the main cause but also being characteristic of acute biliary pancreatitis, acute cholecystitis, cholangitis [1][2]. Although significant progress has been made in recent years in the diagnosis and treatment of mechanical jaundice syndrome in gallstones, there are still many problems and challenges [3][4][5]. Considered a medical-surgical emergency, cholestatic jaundice syndrome requires a surgical approach as early as possible, but in some cases, biliary decompression, carried out both by laborious surgical interventions and by endoscopic methods, induces a worsening of the patient's condition with the installation of some severe evolutionary complications, caused by existing homeostatic disturbances [6].…”