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  • 1
    Electronic Resource
    Electronic Resource
    Developments in liver transplantation (1985)
    Springer
    Surgery today 15 (1985), S. 409-419 
    Details
    ISSN: 1436-2813
    Keywords: liver transplantation ; Cyclosporin A
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Liver transplantation has gained increasing interest. While liver grafting for tumor is successful over prolonged periods only in its early course, liver grafting for end-stage cirrhosis may lead to a long survival. Liver grafting in children is the most successful indication; in adults the results depend largely on timing and indication. Actual developments are mainly seen in the following points: a. Improvement in immunosuppression by use of Cyclosporin A. The resorption and metabolism of the drug, in relation to liver function, have to be carefully observed. b. The tendency to perform liver grafting electively instead of in emergency. c. Improvement in operative management, particularly the use of veno-venous bypass. d. The best possible anaesthesiological and intensive care management for the patients. It can be expected, that these developments will enable continuous improvement of results, particularly in an elective situation. One hundred and forty liver grafts have been done in our institution and the results are discussed herein. Progress in liver transplantation is marked by steadily growing numbers of liver grafts performed, and of centers performing grafts, as well as by improved success rates and the recommendation of the U.S. National Institutes of Health, based on discussions at a liver transplantation consent meeting, held in June 1983. This interest is also reflected in discussions among the medical and non-medical community. The first section of this paper will deal with the present state and results of liver grafting particularly, at our own institution and some actual developments in this field will be discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02470085
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Human hepatic preneoplasia: phenotypes and proliferation kinetics of foci and nodules of altered hepatocytes and their relationship to liver cell dysplasia (1997)
    Springer
    Virchows Archiv 431 (1997), S. 391-406 
    Details
    ISSN: 1432-2307
    Keywords: Key words Foci of altered hepatocytes ; Liver cell dysplasia ; Liver cirrhosis ; Hepatocellular carcinoma ; Proliferating cell nuclear antigen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Foci of altered hepatocytes (FAH) represent preneoplastic lesions, as shown in various animal models of hepatocarcinogenesis, but their significance in the human liver has not been established. The cellular composition, size distribution and proliferation kinetics of FAH in 163 explanted and resected human livers with or without hepatocellular carcinoma (HCC) and their possible association with small-cell change of hepatocytes (SCC) were therefore studied. FAH, including glycogen-storing foci (GSF), mixed cell foci (MCF) and basophilic cell foci, were found in 84 of 111 cirrhotic livers, demonstrating higher incidences in cases with (29/32) than in those without HCC (55/79). FAH were observed more frequently in HCC-free cirrhosis associated with hepatitis B or C virus or chronic alcoholic abuse (high-risk group) (37/47) than in that due to other causes (low-risk group) (12/21). MCF, predominant in cirrhotic livers of the high-risk group, were more proliferative, larger and more often involved in formation of nodules of altered hepatocytes (39.3%) than were GSF (8.5%). The results suggest that the FAH are preneoplastic lesions, MCF being more advanced than GSF. Oncocytic and amphophilic cell foci were also observed, but their significance remains to be clarified. Two types of SCC, namely diffuse and intrafocal SCC, were identified, but only intrafocal SCC was found to be related to increased proliferative activity and more frequent nodular transformation of the FAH involved, suggesting a close association with progression from FAH to HCC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050116
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  • 3
    Electronic Resource
    Electronic Resource
    Tacrolimus-based immunosuppression after liver transplantation: a randomised study comparing dual versus triple low-dose oral regimens (1997)
    Springer
    Transplant international 10 (1997), S. 253-261 
    Details
    ISSN: 1432-2277
    Keywords: Key words Tacrolimus ; liver transplantation ; dual versus triple therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To evaluate the efficacy and safety of oral tacrolimus-based immunosuppressive induction therapy, 130 primary orthotopic liver transplant (OLT) recipients were randomised to treatment in an open, parallel-group, European multicentre trial. Following OLT, patients were immediately administered either tacrolimus (0.10 mg/kg) and prednisolone (dual therapy group) or tacrolimus (0.06 mg/kg) in conjunction with prednisolone and azathioprine (triple therapy group) both orally. Patient survival at 1 year was 79.4 % for the dual therapy group and 88.7 % for the triple therapy group (P = 0.194); 1-year graft survival rates were 76.5 % in the dual therapy group and 80.6 % in the group receiving triple therapy (P = 0.615). The frequencies of rejection (dual therapy 42.6 %, triple therapy 50.0 %; P = 0.482), infection, and other complications (renal, neurological and glucose metabolic disorders) were similar in both groups. Tacrolimus whole blood trough concentrations were detectable on days 1 and 2, respectively, in the dual and triple therapy treatment groups whilst median tacrolimus blood concentrations in the triple therapy group reached levels similar to those in the dual therapy group on postoperative day 11 following a steady increase in dose. After 1 year, 54.4 % of the patients randomised to dual therapy were receiving tacrolimus monotherapy and only 56.4 % of the patients randomised to triple therapy continued to receive azathioprine. In conclusion, oral tacrolimus-based immunosuppression is both potent and safe when administered as induction therapy after OLT. Treatment may commence at either 0.06 or 0.10 mg/kg per day, but doses may need to be increased to the latter value within the first 10 days to maintain effective immunosuppression.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050054
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  • 4
    Electronic Resource
    Electronic Resource
    Liver transplantation for hepatocelluar carcinoma, with additional reference to bench surgery (1994)
    Springer
    Journal of hepato-biliary-pancreatic surgery 1 (1994), S. 133-140 
    Details
    ISSN: 1436-0691
    Keywords: hepatocellular carcinoma ; liver transplantation ; resectability ; bench procedure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 98 liver transplantations for hepatocellular carcinoma during a 20-year period, a strong correlation was found between survival and UICC tumor stage. From these results, tumor stage IV and the presence of lymph node metastases should be considered exclusion criteria for liver transplantation. It remains an open issue whether in potentially resectable stage I or II hepatocellular carcinoma with underlying cirrhosis liver transplantation should be preferred. Generally, resection will remain the treatment of choice. For anatomic restrictions without functional impairment, extension of resectability can be obtained by total vascular occlusion and hypothermic perfusion of the liver via different techniques, such as in situ, ante situm, or ex situ (“bench”) procedure. The feasibility of these techniques was demonstrated in five patients with hepatocellular carcinoma; there was no postoperative mortality in the group and the survival time was 12–27 months. According to this experience, appropriate indications for this procedure are patients where liver transplantation is contraindicated, the improvement of resectability in borderline cases to avoid liver transplantation, and the possible extension of resectability in conventionally resectable tumors. With regard to promising results in the literature, further investigations will be required to evaluate tumor stage and multimodality therapy concepts including in situ, ante situm, and the bench procedure, as well as liver transplantation, as complementary treatment options to conventional resection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01222236
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    Paper (German National Licenses)
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