Transplantation proceedings
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At present, organ transplantation activity in Poland is located in the middle among European Union countries. There are appropriate law regulations, well-organized legal structures, well-educated transplant teams, good transplantation results, and case registries. There are 24 organ transplant teams in 20 centers, including 46 programs. ⋯ Every year almost 1500 organs are procured from about 500 cadaveric heart-beating donors (9-14 per million people [pmp]) with 50 from living donors: 800 to 1000 kidneys (21-28 pmp); over 200 livers (5-6 pmp); and 60 to 100 hearts (1.6-2.7 pmp). National transplant registries are maintained in Poltransplant including a central registry of refusals (the policy of presumed consent with registered objection on donation after death is implemented), waiting lists, a cadaveric and living donor registry, and a transplant registry. There are still some actions that should be undertaken to strengthen the transplantation system in Poland, to increase organ availability, to enhance the efficiency and accessibility of transplantation systems, and to improve quality and safety: namely, increasing deceased donations to their full potential, appointing transplant coordinators in every hospital where there is the potential for organ donation, promoting quality improvement programs, and promoting living donation.
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Endosonography (EUS), which merges endoscopic and ultrasound examinations, is a useful modality to display abnormal vessels that develop in the intrinsic circulation, frequently called "deep" varices. If these pathological veins exceed of 5 mm diameter, they significantly increase the risk of bleeding among patients with cirrhosis. In the most recent pilot study EUS proved useful to assess children for orthotopic liver transplantation (OLT). ⋯ EUS offers a precise evaluation of portal hypertension in OLT candidates. "Deep" potentially dangerous varices, which are undetected with routine endoscopy, were noted in a significant proportion of patients. The role of EUS in prioritizing subjects for OLT must be evaluated in a prospective study.
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Chronic heart failure and airway obstruction produce overlapping syndromes. Existent criteria for the diagnosis and grading of airway obstruction based on spirometry results may be inadequate in the presence of coexistent cardiac failure. The cardiac component of pulmonary function tests (PFT) can be measured in patients undergoing orthotopic heart transplantation (OHT). ⋯ Chronic heart failure contributed to significant FEV1 reduction, which limits the usefulness of PFT for diagnosis and grading of airway obstruction. FEV1%FVC, the main diagnostic criterion of chronic obstructive lung disease, seems to be an index independent of concomittant heart function impairment.
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Liver transplantation (OLT) is accepted as the standard therapy for end-stage liver disease. The current shortage of organ donors has led to the use of split grafts and living related donors to provide timely liver transplants for these children. Herein we have reported our experience with pediatric OLT over a 9-year period. ⋯ Our results demonstrated that pediatric OLT is a feasible undertaking in Iran. The organ shortage in our area led to liberal use of living related and split-liver techniques. The overall results of pediatric OLT in Iran were acceptable.
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Occurrence of chronic kidney disease (CKD) after hematopoietic cell transplantation (HCT) is rare with relatively few reported cases. The aim of this study was to evaluate the frequency of CKD among patients who received HCT for hematologic and nonhematologic disorders. ⋯ The frequency of CKD in this study seems to be high. It is important to know the specific type of kidney damage, to determine when to be aware of the time of occurrence of renal complications and to understand the best methods to treat patients with renal injury secondary to nephrotic syndrome and idiopathic CKD.