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.
This subject underlines the most important perioperative factors that predispose to early post-liver transplant respiratory complications. Despite advances in surgical techniques and anesthesiological management the lung may still suffer throughout the perioperative period from various types of injury, with different ensuing ventilatory impairments, and different clinical outcomes. The incidence, etiology, pathophysiological features, clinical manifestations, preventing measures, and outcomes of post-operative respiratory disorders in this setting are also reported.
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