Early Postoperative Problems After Lung Transplantation: First-Year Experiences in Light of the Newly Established National Hungarian Lung Transplantation Program

Until December 2015, Hungarian patients' lung transplantations (LTXs) were done at the Medical University of Vienna. After several years of preparation, the National Hungarian Lung Transplantation Program was launched and the first milestone LTX was performed in Budapest on December 12, 2015. During the first 12 months, 18 lung transplantations took place in Hungary, including the first one. Data were retrospectively collected to analyze the early postoperative problems of the first 18 LTX patients of the newly launched Hungarian National Lung Transplantation Program. No patients with primary pulmonary hypertension and no children were transplanted during this period. We found that the postoperative problems of LTX differ from those of other huge thoracic surgeries both in a quantitative and a qualitative manner. We also reveal problems that are not present with other thoracic surgeries. The wide variety of problems during the early postoperative period after LTX can be managed by a highly organized and coordinated interdisciplinary teamwork.     

Abdominal Compartment Syndrome After Liver Transplant in Drug-Induced Acute Liver Failure: A Case Report

The incidence of drug-induced acute liver failure (ALF) has been increasing in recent years. Despite the complex intensive treatment, liver transplant should be performed in progressive cases. A systemic inflammatory response syndrome and the burden of surgical intervention promote abdominal compartment syndrome (ACS); observed preoperatively, they are significant negative prognostic factors.The CaseWe demonstrate a young woman with liver transplant after ALF and a consecutive ACS. We presumed drug toxicity in the background of the rapidly progressive ALF, based on the preoperative hematologic examination and the histology of the removed liver. An ACS has occurred in the postoperative period that must have been resolved with mesh, and later, anatomic segment 2-3 resection had to be performed to further decrease the pressure. The patient left the hospital after 62 days with good graft function.DiscussionA complex intensive care is mandatory in the case of orthotopic liver transplant for ALF. Outcomes are good after orthotopic liver transplant. An ACS might occur after surgery. In these rare cases a delayed abdominal closure or even a liver resection can be the only solution and sometimes an urgent need to resolve the life-threatening problem.     

The effect of haemorrhage on gastric circulation and acid output in the dog.

Blood flow in the portal vein and the left gastric artery was measured electromagnetically and gastric mucosal perfusion was determined by pertechnetate clearance in anaesthetized dogs. Bleeding the animals to arterial pressures of 100 and 60 mmHg respectively reduced portal venous flow and markedly increased the mesenteric inflow resistance. Left gastric arterial and gastric mucosal blood flow were decreased without significant vascular resistance change only in proportion to perfusion pressure reduction. Gastric acid output decreased but did not stop even at the lower level of haemorrhagic hypotension. It is concluded that ischaemia and acid, probably in the presence of regurgitated bile, may play an important role in the development of stress ulcers.     

Hyperbaric oxygen therapy in injured subjects

Intermittent hyperbaric oxygen therapy was given to 19 patients with severe injury to limbs, vascular damage, extensive skin loss, and anaerobic infection associated with open fractures. The object was to save limbs which, from past experience would have required amputation. It was also used to preserve the vitality of skin-grafts. In general a pressure of $\text{2–2}\text{1}\text{2}$ atmospheres was used for 2 hours. Each patient was treated on average 10 times and measurement of skin temperature was found to be a useful aid in prognosis. In 13 cases the procedure was beneficial. It is emphasized that further experience is needed to decide on the indications and value of this treatment in injured subjects. The present experience is encouraging.     

Endogenous nickel release in injured patients: a possible cause of myocardial damage

Atom absorption spectrophotometry was used for the study of serum nickel levels in 58 injured patients. From 27 autopsies an electron cytochemical examination of the myocardium was performed in 19 patients. In patients with severe burns and cerebral injury, the serum nickel content showed a significant increase in the early period after injury. In these cases direct traumatic or toxic damage to the central nervous system and, in cases of early death, cerebral oedema, were present. The ECG tracings revealed disturbances in repolarization in a large majority. Nickel-dimethylglyoxim complex precipitates were found in the myocardium of all patients who died. In addition to disorientation, increased serum nickel levels and abnormal ECG records were observed in septicaemia. On the basis of these observations and the experimental data, we suggest that one of the causes of post-traumatic myocardial damage may be endogenous nickel release as part of the homeostatic disequilibrium arising as a direct or indirect effect of the injury.     

Breakthrough in the Transplantation of Thoracic Organs in Hungary

In 2016 the focus was, by all means, on the transplantation on thoracic organs. More than 50 heart transplantations were performed in this year. With this achievement, the Hungarian Heart Transplantation Program became one of the leading programs in the world. In the Thoracic Surgery Unit of the National Institute of Oncology and the Thoracic Surgery Department of Semmelweis University the first successful lung transplantation was carried out on December 12, 2015 when the Hungarian Lung Transplantation Program was launched.