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Open access

Rafał Stankiewicz, Konrad Kobryń, Waldemar Patkowski and Marek Krawczyk


Hemangiomas are the most common benign primary hepatic neoplasms, often being incidentally discovered. In most of the cases they are small and asymptomatic. It is widely accepted that clinical intervention is indicated only for symptomatic hemangiomas.

We present a case of an asymptomatic giant hemangioma managed by enucleation due to its atypical localization. The hemangioma, originally located in segment 5, was now described in Computer Tomography (CT) Imaging as separating the gallbladder from the liver parenchyma. A careful evaluation of images revealed proximity to the portal vein (PV), right hepatic artery (RHA), right hepatic duct (RHD) and right branch of the portal vein (RBPV). Thus, in the case of an emergent operation, surgical maneuvers in the area of the altered hepatic anatomy and proximity to the hemangioma itself, would in fact increase the risk endangering the patient’s life. After patient’s consent, a surgical enucleation en block with the gall-bladder was performed. It is of great importance that specifically selected, asymptomatic patients diagnosed with a giant hemangioma, with the above mentioned or similar localization should be considered for surgical treatment.

Open access

Łukasz Masior, Maciej Krasnodębski, Konrad Kobryń, Michał Grąt and Marek Krawczyk

Open access

Michał Grąt, Oskar Kornasiewicz, Karolina Grąt, Arkadiusz Antczak, Joanna Ligocka, Wacław Hołówko, Karolina Maria Wronka, Konrad Kobryń, Michał Skalski, Leszek Pączek and Marek Krawczyk


The number of elderly patients undergoing liver transplantation (LT) is increasing worldwide.

The aim of the study was to evaluate the impact of recipient age exceeding 60 years on early and long-term outcomes after LT.

Material and methods. This study comprised data of 786 patients after primary LT performed at a single center between January 2005 and October 2012. Patients over and under 60 years of age were compared with respect to baseline characteristics and outcomes: postoperative mortality (90-day) and 5-year patient (PS) and graft (GS) survival. Associations between recipient age exceeding 60 years and LT results were assessed in multiple Cox regression models.

Results. Recipients older than 60 years (n=107; 13.6%) were characterized by more frequent hepatitis C virus infections (p<0.001), malignancies (p<0.001), and cardiovascular comorbidities (p<0.001); less frequent primary sclerosing cholangitis (p=0.002) and Roux-en-Y hepaticojejunostomy (p<0.001); lower Model for End-stage Liver Disease (MELD; p=0.043); and increased donor age (p=0.012). Fiveyear PS of older and younger recipients was 72.7% and 80.6% (p=0.538), while the corresponding rates of GS were 70.3% and 77.5% (p=0.548), respectively. Recipient age exceeding 60 years was not significantly associated with postoperative mortality (p=0.215), PS (p=0.525) and GS (p=0.572) in multivariate analyses. The list of independent predictors comprised MELD (p<0.001) for postoperative mortality; malignancies (p=0.003) and MELD (p<0.001) for PS; and malignancies (p=0.003), MELD (p<0.001) and donor age (p=0.017) for GS.

Conclusions. Despite major differences between elderly and young patients, chronological age exceeding 60 years alone should not be considered as a contraindication for LT.

Open access

Marek Krawczyk, Michał Grąt, Karolina Grąt, Karolina Wronka, Maciej Krasnodębski, Jan Stypułkowski, Łukasz Masior, Wacław Hołówko, Joanna Ligocka, Paweł Nyckowski, Tadeusz Wróblewski, Rafał Paluszkiewicz, Waldemar Patkowski, Krzysztof Zieniewicz, Leszek Pączek, Piotr Milkiewicz, Urszula Ołdakowska-Jedynak, Bogusław Najnigier, Krzysztof Dudek, Piotr Remiszewski, Ireneusz Grzelak, Oskar Kornasiewicz, Marcin Kotulski, Piotr Smoter, Mariusz Grodzicki, Michał Korba, Piotr Kalinowski, Michał Skalski, Krzysztof Zając, Rafał Stankiewicz, Marta Przybysz, Bartosz Cieślak, Łukasz Nazarewski, Małgorzata Nowosad, Konrad Kobryń, Michał Wasilewicz, Joanna Raszeja-Wyszomirska, Jolanta Piwowarska, Dorota Giercuszkiewicz, Joanna Sańko-Resmer, Sławomir Rejowski, Monika Szydłowska-Jakimiuk, Barbara Górnicka, Bogna Wróblewska-Ziarkiewicz, Michał Mazurkiewicz, Grzegorz Niewiński, Jacek Pawlak and Ryszard Pacho


Liver transplantation is a well-established treatment of patients with end-stage liver disease and selected liver tumors. Remarkable progress has been made over the last years concerning nearly all of its aspects.

The aim of this study was to evaluate the evolution of long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw).

Material and methods. Data of 1500 liver transplantations performed between 1989 and 2014 were retrospectively analyzed. Transplantations were divided into 3 groups: group 1 including first 500 operations, group 2 including subsequent 500, and group 3 comprising the most recent 500. Five year overall and graft survival were set as outcome measures.

Results. Increased number of transplantations performed at the site was associated with increased age of the recipients (p<0.001) and donors (p<0.001), increased rate of male recipients (p<0.001), and increased rate of piggyback operations (p<0.001), and decreased MELD (p<0.001), as well as decreased blood (p=0.006) and plasma (p<0.001) transfusions. Overall survival was 71.6% at 5 years in group 1, 74.5% at 5 years in group 2, and 85% at 2.9 years in group 3 (p=0.008). Improvement of overall survival was particularly observed for primary transplantations (p=0.004). Increased graft survival rates did not reach the level of significance (p=0.136).

Conclusions. Long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery are comparable to those achieved in the largest transplant centers worldwide and are continuously improving despite increasing recipient age and wider utilization of organs procured from older donors.

Open access

Marek Krawczyk, Michał Grąt, Krzysztof Barski, Joanna Ligocka, Arkadiusz Antczak, Oskar Kornasiewicz, Michał Skalski, Waldemar Patkowski, Paweł Nyckowski, Krzysztof Zieniewicz, Ireneusz Grzelak, Jacek Pawlak, Abdulsalam Alsharabi, Tadeusz Wróblewski, Rafał Paluszkiewicz, Bogusław Najnigier, Krzysztof Dudek, Piotr Remiszewski, Piotr Smoter, Mariusz Grodzicki, Michał Korba, Marcin Kotulski, Bartosz Cieślak, Piotr Kalinowski, Piotr Gierej, Mariusz Frączek, Łukasz Rdzanek, Rafał Stankiewicz, Konrad Kobryń, Łukasz Nazarewski, Dorota Leonowicz, Magdalena Urban-Lechowicz, Anna Skwarek, Dorota Giercuszkiewicz, Agata Paczkowska, Jolanta Piwowarska, Remigiusz Gelo, Paweł Andruszkiewicz, Anna Brudkowska, Renata Andrzejewska, Grzegorz Niewiński, Beata Kilińska, Aleksandra Zarzycka, Robert Nowak, Cezary Kosiński, Teresa Korta, Urszula Ołdakowska-Jedynak, Joanna Sańko-Resmer, Bartosz Foroncewicz, Jacek Ziółkowski, Krzysztof Mucha, Grzegorz Senatorski, Leszek Pączek, Andrzej Habior, Robert Lechowicz, Sławomir Polański, Elżbieta Leowska, Ryszard Pacho, Małgorzata Andrzejewska, Olgierd Rowiński, Sławomir Kozieł, Jerzy Żurakowski, Bogna Ziarkiewicz-Wróblewska, Barbara Górnicka, Piotr Hevelke, Bogdan Michałowicz, Andrzej Karwowski and Jerzy Szczerbań

1000 Liver Transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw - Analysis of Indications and Results

The aim of the study was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw.

Material and methods. Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival.

Results. The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations.

Conclusions. Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.