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  • 1
    Electronic Resource
    Electronic Resource
    Mycophenolate mofetil added to immunosuppression after liver transplantation – first results (1997)
    Springer
    Transplant international 10 (1997), S. 223-228 
    Details
    ISSN: 1432-2277
    Keywords: Key words Mycophenolate ; mofetil ; Liver transplantation ; Immunosuppressive agents
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Mycophenolate mofetil (MMF) has been used successfully as an immunosuppressive agent after kidney and heart transplantation, but experience with MMF after liver transplantation is still limited. Between August 1995 and January 1996, we treated 20 patients with MMF after orthotopic liver transplantation in an open, prospective study. Five out of eight patients with acute rejection and one patient with early chronic rejection showed a complete response after MMF was added to the immunosuppression. Three patients with chronic rejection did not improve, one died, and two have stable graft function at present. In eight patients who suffered from toxicity, a reduction in the dosage of tacrolimus was attempted with simultaneous MMF therapy. One patient died due to multiple organ failure. Liver function improved completely in one other patient, and partially in three patients after adding MMF. In the remaining three patients, a reduced dosage of tacrolimus or cyclosporin, together with MMF, reduced toxicity, not significantly. In conclusion, MMF appears to be a safe and potentially useful adjuvant immunosuppressive agent for rescue and maintenance therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050046
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  • 2
    Electronic Resource
    Electronic Resource
    Orthotopic liver transplantation after extended bile duct resection as treatment of hilar cholangiocarcinoma (1998)
    Springer
    Transplant international 11 (1998), S. S206 
    Details
    ISSN: 1432-2277
    Keywords: Key words Hilar cholangiocarcinoma ; Extended bile duct resection ; Liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although the surgical treatment of hilar cholangiocarcinoma represents the only potentially curative option, survival figures remain low over the long term. After hilar and partial hepatic resections for hilar cholangiocarcinoma, locoregional tumor recurrence appears as the primary site of failure. From April 1992 to April 1996, 14 patients underwent extended bile duct resections. Extended bile duct resections combine total hepatectomy, partial pancreatoduodenectomy, and liver transplantation in an attempt to eradicate the entire biliary tract without dissecting the hepatoduodenal ligament. The postoperative 60-day mortality rate was 14% (n = 2).The rate of curative resections was 93% (13 of 14 extended bile duct resections). One- and 4-year survival rates after curative resections were 56% and 30%, respectively. The rate of curative resections increased by combining total hepatectomy, partial pancreatoduodenectomy, and liver transplantation, i. e., extended bile duct resection. However, survival figures have not improved accordingly. Therefore, this extended surgical procedure has to be implemented with caution and possibly not without modifications (e. g., multimodal treatment).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050462
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  • 3
    Electronic Resource
    Electronic Resource
    Changes at the extracellular matrix during acute and chronic rejection in human liver transplantation (1998)
    Springer
    Transplant international 11 (1998), S. S377 
    Details
    ISSN: 1432-2277
    Keywords: Key words Extracellular matrix ; Liver transplantation ; Acute rejection ; Early chronic rejection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We have previously observed changes at the extracellular matrix (ECM) which significantly correlated with the extent of preservation and reperfusion injury. In the present study, we attempted to investigate whether the ECM may be also involved in the pathophysiological sequelae of acute and chronic rejection. Of 81 patients monitored for the ECM parameters laminin, hyaluronic acid, fibronectin receptor, and transforming growth factor (TGF)-β , 28 patients developed acute rejection (〈 1 month), in 14 patients (17.4 %) acute rejection was steroid resistant, 4 patients (4.5 %) developed early chronic rejection following acute steroid-resistant rejection. Acute and chronic rejection were confirmed by established clinical and histological criteria. Laminin levels were significantly increased in patients experiencing acute steroid-resistant rejection (4204 ± 133 ng/ml; P K 0.01) compared with patients with steroid-sensitive rejection (1059 ± 27.3 ng/ml) and with an uneventful postoperative course (1214 ± 17.4 ng/ml). No increase in laminin was observed in those four patients who developed early chronic rejection (1099 ± 58.7 ng/ml). Hyaluronic acid, fibronectin receptor, and TGF-β levels also increased in patients with acute steroid-resistant rejection; hyaluronic acid: 290 ± 10.8 μg/l vs 154 ± 13.6 μg/l and 131 ± 11.7 μg/l in patients with steroid-sensitive and no rejection, respectively; fibronectin receptor: 1003 ± 23.5 ng/ml vs 573 ± 24.8 ng/ml and 428 ± 13.6 ng/ml in patients with steroid-sensitive and no rejection, respectively; and TGF-β : 393 ± 14.9 pg/ml versus 315 ± 10.7 pg/ml and 233 ± 8.9 pg/ml in patients with steroid-sensitive and no rejection, respectively. A further increase in hyaluronic acid levels was observed in patients who developed early chronic rejection, while fibronectin receptor and TGF-β levels remained low, similarly to laminin levels. The increase in laminin, hyaluronic acid, fibronectin receptor, and TGF-β during acute steroid-resistant rejection may be stimulated by the rejection-related release of cytokines and adhesion molecules which paralleled the increase in ECM parameters. The lack of increase in laminin and fibronectin receptor levels in those patients who developed early chronic rejection may reflect an inability to recover from acute rejection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050502
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  • 4
    Electronic Resource
    Electronic Resource
    Leberteilresektion nach posttraumatischem Leberabsceß (1998)
    Springer
    Der Chirurg 69 (1998), S. 985-988 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Post-traumatic pyogenic liver abscess ; Diagnosis ; Surgical therapy. ; Schlüsselwörter: Posttraumatischer ; pyogener Leberabsceß ; Diagnostik ; chirurgische Therapie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Der posttraumatische pyogene Leberabsceß ist ein seltenes Krankheitsbild. Wir stellen den Fall eines 38 jährigen Patienten vor, der sich 3 Monate nach einem stumpfen Bauchtrauma mit einem ausgedehnten, multiloculären Leberabsceß und rechtsseitigem Pleuraempyem in unserer Klinik vorstellte. Die definitive Therapie bestand aus einer Hemihepatektomie rechts und Pleuradrainage. Symptomatik, Diagnose und die verschiedenen therapeutischen Möglichkeiten werden anhand dieses Fallberichts erörtert.
    Notes: Summary. Post-traumatic pyogenic liver abscess is a rare disease. We present the case of a 38-year-old man with multilocular liver abscess and pleural empyema following blunt abdominal trauma. The patient had a prodrome lasting 3 months before presenting in our department. The therapy included partial hepatectomy and pleural drainage. Clinical signs, diagnosis and possible therapy are discussed in this case report.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050527
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  • 5
    Electronic Resource
    Electronic Resource
    The effect of temporary hepatic ischemia on liver surface pH and potassium ion activity in the rat (1995)
    Springer
    Langenbeck's archives of surgery 380 (1995), S. 58-61 
    Details
    ISSN: 1435-2451
    Keywords: Hepatische Isch⇐ie ; Organfunktion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Folgen einer hepatischen Ischämie können durch eine Vielzahl funktioneller und morphologischer Methoden analysiert werden. In der vorliegenden Studie wurden mittels eines Organmonitoringsystems die pH-Werte und K+-Aktivitäten mit ionenselektiven Elektroden an der Leberoberfläche gemessen. In 4 Versuchsgruppen wurden Ratten (n=6) einer kompletten, selektiv arteriellen und portalen warmen Ischämie für 15 min durch Klemmung des Ligamentum hepatoduodenale, der A. hepatica propria oder der Pfortader ausgesetzt und anschlieβend reperfundiert. Eine Gruppe diente als Kontrolle. Eine komplette oder portale Ischämie war durch einen sofortigen pH-Abfall und einen verzögerten Anstieg der K+-Aktivität gekennzeichnet. Eine arterielle Ischämie hatte im Vergleich zur Kontrollgruppe kaum einen Effekt. Nach Reperfusion kehrten beide Meβparameter zu Ausgangswerten zurück. Das Organmonitoringsystem erlaubt eine nichtinvasive Messung ionaler Veränderungen während Organentnahmen, Ischämie und Reperfusion und könnte ein zusätzliches Kriterium zur Beurteilung der Organviabilität dastellen.
    Notes: Abstract The effects of hepatic ischemia can be analyzed with a wide variety of functional and morphological methods. In this study we used a new organ monitoring device that accurately determines pH and K+ activities on the liver surface with ion-selective electrodes. Four groups of rats (n=6 each) were subjected to complete, arterial or portal warm ischemia for 15 min (achieved by clamping of the hepatoduodenal ligament, the hepatic artery or the portal vein) and subsequent reperfusion. One group was sham-operated. Complete and portal ischemia were characterized by an immediate decline of pH and a more retarded rise of K+ activity on the liver surface. Arterial ischemia had almost no effect on these two parameters when compared with the sham group. Upon reperfusion the shifts of pH and K+ activity reversed towards initial baseline values. The organ monitoring system offers the option to assess ional shifts non-invasively during organ procurement, ischemia and reperfusion and may be used as an additional criterion for the estimation of organ viability.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00184417
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  • 6
    Electronic Resource
    Electronic Resource
    Mycobacterial infection after liver transplantation (1995)
    Springer
    Langenbeck's archives of surgery 380 (1995), S. 171-175 
    Details
    ISSN: 1435-2451
    Keywords: Lebertransplantation ; Infektion ; Mykobakterium ; Tuberkulose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei 5 von 462 Patienten (1,2%) trat nach Lebertransplantation Tuberkulose auf. In einem Fall wurde Reinfektion, in 4 Fällen Neuinfektion angenommen. Die klinischen Verläufe waren sehr unterschiedlich: von asymptomatischer offener Lungentuberkulose bis zu disseminierter Erkrankung mit zerebralem Tuberkulom und Konvulsionen. Nach antituberkulöser Tripelmedikamententherapie überlebten 4 Patienten. Es wurde bisher über nur sehr wenige Tuberkulosefälle nach Lebertransplantation berichtet: in der Medizinliteratur über 4 Fälle and in der hier vorgelegten Untersuchung über 5. Dennoch ist anzunehmen, daß Häufigkeit, Verlauf and Ausgang einer Tuberkuloseinfektion nach Lebertransplantationen ähnlich sind wie nach Nierentransplantationen, bei denen etwa 150 Fälle erfaßt wurden.
    Notes: Abstract Tuberculosis occurred in 5 (1.2%) of 462 liver transplant recipients. De novo infection was assumed in 4 patients and a recurrent infection in 1. The clinical courses varied, from asymptomatic open lung tuberculosis to disseminated disease with cerebral tuberculoma and convulsions. Four patients survived with anti-tuberculous triple-drug therapy. Very few cases of tuberculosis after liver transplantation have been reported (4 patients in the medical literature and 5 patients in this paper). However, the incidence, course of infection, and outcome seem to be similar to those of tuberculosis in renal transplant recipients, approximately 150 cases of which are known.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00207725
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