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ABSTRACT: Die Lebendorganlebertransplantation hat 16Jahre nach ihrer ersten erfolgreichen Durchführung in Deutschland einen relativ
geringen, aber festen Platz in der Behandlung des Leberversagens. Beide Anwendungsbereiche, sowohl im kindlichen als auch
im Erwachsenenalter, bleiben problematisch hinsichtlich des Aufwandes, der erwarteten Ergebnisse und der Bewertung der Spenderrisiken.
Sie wird deshalb auf forschungsorientierte und motivierte Institutionen begrenzt bleiben, um in Zukunft als Alternative zur
postmortalen Organspende eine breitere Anwendung begründen zu können. Grundsätzlich begegnen ihr in Deutschland dazu noch
die gleichen Vorbehalte wie in der Nierenlebendspende.
Sixteen years after its first successful application, living donor liver transplantation now has a small but well-established
role in treatment for liver failure in Germany. It remains problematic in both child and adult patients concerning effort,
expected results, and assessment of risks to the donor. Therefore the method shall remain limited to more research-oriented
institutions for the time being before it can be established more broadly as an alternative to postmortal donation. In Germany
it presents generally the same limitations as living donor kidney transplantation.
Der Chirurg 04/2012; 79(2):135-143. · 0.70 Impact Factor
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A. Radtke, S. Nadalin,
G. C. Sotiropoulos,
E. P. Molmenti,
T. Schroeder,
C. Valentin-Gamazo,
H. Lang,
M. Bockhorn,
H.O. Peitgen,
C. E. Broelsch,
M. Malagó
[show abstract]
[hide abstract]
ABSTRACT: An adequate venous outflow is essential for securing viability of both graft and remnant in adult living donor liver transplantation
(ALDLT). Seventy-five potential live liver donors were evaluated for LDLT by means of an “all-in-one” CT, which defined the
biliary tree, portal vein, hepatic artery, and hepatic vein anatomy. The acquired data sets were further analysed by means
of the software HepaVision (MeVis, Germany). Only a minority (29%) of potential donors were found to have a vascular and biliary
anatomy consistent with the classically described “normal” patterns. The vast majority (71%) had “anatomical variations”.
Thirty-nine (52%) donors underwent ALDLT hepatectomy. The right hepatic vein was dominant in 64 cases, representing 48±6%
of the total liver volume (TLV). The middle hepatic vein was dominant in 11 cases, making up 40±8% of the TLV. The left
hepatic vein was never dominant. The volume contribution of the middle hepatic vein (MHV) was 114–782ml for the right and
87–419ml for the left hemiliver. Computer-assisted planning allows for the 3D reconstruction of the vascular and biliary
anatomy, automatic calculation of the total and territorial liver volumes, and risk analysis of hepatic vein dominance relationships.
This comprehensive data acquisition supports preoperative evaluation and provides a high degree of safety for donors and improved
outcomes for recipients.
World Journal of Surgery 04/2012; 31(1):175-185. · 2.36 Impact Factor
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ABSTRACT: Complex bile duct injury (BDI) is a serious condition requiring hepatectomy in some instances. The present study was to analyse the factors that led to hepatectomy for patients with BDI after laparoscopic cholecystectomy (LC).
The medical records of patients referred to our department from April 1998 to September 2007 for management of BDI following LC were reviewed, and patients who underwent hepatectomy were identified. The type of BDI, indication for liver resection, interval between LC and liver surgery, histology of the liver specimen, postoperative morbidity and long-term results were analysed.
Hepatectomy was performed in 10 of 76 patients (13.2%), with BDI either as isolated damage or in combination with vascular injury (VI). Proximal BDI (defined as disruption of the biliary confluence) and injury to the right hepatic artery were found to be independent risk factors of hepatectomy, with odds ratios of 16 and 45, respectively. Five patients required early liver resection (within 5 weeks post-LC) to control sepsis caused by confluent liver necrosis or bile duct necrosis. In five patients, hepatectomy was indicated during long-term follow-up (over 4 months post-LC) to effectively manage recurrent cholangitis and liver atrophy. Despite of high postoperative morbidity (60%) and even mortality (10%), the long-term results (median follow-up of 34 months) were satisfactory, with either no or only transitory symptoms in 67% of the patients.
Hepatectomy may inevitably be necessary to manage early or late complications after LC. Proximal BDI and VI were the two independent risk factors of hepatectomy in this series.
Journal of Gastrointestinal Surgery 11/2011; 16(4):815-20. · 2.83 Impact Factor
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ABSTRACT: Glutathione-S-transferase (GST) subtype α and π are differentially expressed in adult liver tissue. Objective of the study was if GST α and π may serve as predictive markers for liver surgery, especially transplantations.
13 patients receiving living donor liver transplantation (LDLT) and their corresponding donors were analyzed for standard serum parameters (ALT, AST, γGT, bilirubin) as well as GST-α and -π before LDLT and daily for 10 days after LDLT. Patients (R) and donors (D) were grouped according to graft loss (R1/D1) or positive outcome (R2/D2) and above named serum parameters were compared between the groups.
R1 showed significantly increased GST-α and significantly lower GST-π levels than R2 patients or the donors. There was a positive correlation between GST-α and ALT, AST as well as bilirubin and a negative correlation to γGT. However, γGT correlated positively with GST-π. Graft failure was associated with combined low GST-π levels in donors and their recipients before living donor liver transplantation.
Our data suggest that high GST-α serum levels reflect ongoing liver damage while GST-π indicates the capacity and process of liver regeneration. Additionally, GST-π may be useful as marker for optimizing donor and recipient pairs in living donor liver transplantation.
European journal of medical research 01/2011; 16(1):34-40. · 1.13 Impact Factor
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A Radtke,
G Sgourakis,
G C Sotiropoulos,
S Beckebaum,
E P Molmenti,
F H Saner,
T Schroeder, S Nadalin,
A Schenk,
H Lang,
M Malagó,
C E Broelsch
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to delineate an algorithm for donor and recipient criteria and middle hepatic vein (MHV) management in right-graft live-donor liver transplantation (LDLT) on the basis of computerized 3-dimensional computed tomographic image analysis.
Data on 94 consecutive right-graft LDLTs were prospectively collected. Graft and remnant data for the first 23 cases were retrospectively evaluated by means of 3-dimensional computed tomographic reconstructions, and on the basis of that preliminary series, a graft selection algorithm using 3 parameters-hepatic vein dominance classification, graft and remnant graft volume/body weight ratios, and congestion volumes-was created. It was subsequently applied to the next 71 right-graft LDLTs.
Fifty-nine right grafts contained the MHV. Four of the 12 grafts with no MHVs required MHV reconstructions. In 18 cases, small liver grafts were used. The postoperative function of liver grafts and remnants with versus without MHVs was not statistically different.
The proposed algorithm favored the inclusion of the MHV with the right grafts. It also allowed for the procurement of grafts that were potentially small for size without compromising donor or recipient safety.
American journal of surgery 05/2010; 199(5):708-15. · 2.36 Impact Factor
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ABSTRACT: Patients with end-stage liver disease, particular following liver transplantation, are a major challenge for the intensivist. The recipient is at risk for cardiac decompensation, respiratory failure following reperfusion, and kidney failure. This review will focus on these topics to provide useful information concerning pathophysiology and treatment. Intensivists, who are involved in the postoperative care of liver transplant patients, have to be aware of these problems.
Transplantation Proceedings 12/2008; 40(9):3206-8. · 1.00 Impact Factor
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I Fouzas,
G Sgourakis,
K M Nowak,
H Lang,
V R Cicinnati,
E P Molmenti,
F H Saner, S Nadalin,
V Papanikolaou,
C E Broelsch,
A Paul,
G C Sotiropoulos
[show abstract]
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ABSTRACT: The purpose of this study was to evaluate our experience with orthotopic liver transplantation (OLT) using grafts from septuagenarians.
Seventeen adult patients underwent transplantation with grafts from donors 70 years of age or older during an 8-year period.
The median donor age was 73 years (range, 70-83). Eleven (64.7%) donors had experienced at least 1 hypotensive period and received vasoactive drugs. Median cold and warm ischemia times were 7.25 hours and 35 minutes, respectively. Two recipients underwent retransplantation because of dysfunction or primary nonfunction. Morbidity rate was 47% and hospital mortality rate was 23.5%. After a median follow-up of 34.5 months (range, 3-84 months), 5 additional patients died. Median patient survival was 17 months (range, 0-84 months). One-, 3-, 5-, and 7-year cumulative survival rates were 69.7%, 57.5%, 46.2%, and 23.3%, respectively. Only graft dysfunction (P = .042) was observed to be an independent predictor of survival upon multivariate analysis.
Although grafts from septuagenarians allow for expansion of the donor pool, long-term recipient survival is inferior to that encountered with younger donors.
Transplantation Proceedings 12/2008; 40(9):3198-200. · 1.00 Impact Factor
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I Fouzas,
G C Sotiropoulos,
H Lang, S Nadalin,
S Beckebaum,
G Sgourakis,
F H Saner,
A Radtke,
V Papanikolaou,
H A Baba,
A Paul,
C E Broelsch,
M Malagó
[show abstract]
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ABSTRACT: Living donor liver transplantation (LDLT) represents an alternative to expand the organ pool for adult patients with hepatocellular carcinoma (HCC) and end-stage liver disease. The purpose of this study was to demonstrate our institutional experience using criteria exceeding those of the University of California San Francisco (UCSF).
Between September 1998 and December 2006, 22 LDLTs were performed for HCC among patients exceeding the UCSF criteria.
There were 17 men and 5 women of median age 55 years. Multifocal tumors were present in 19 of 22 patients. Tumor grading was: grade I (n = 8), grade II (n = 10), and grade III (n = 4). Microvascular invasion was observed in 7 liver explants. Five patients died from complications unrelated to HCC recurrence at 2, 6, 9, 10, and 14 months' posttransplant. Seven patients developed tumor recurrences at 3, 3, 5, 7, 9, 10, and 35 months after LDLT, and 4 died at 6, 10, 17, and 75 months' posttransplantation. Currently, 13 patients are alive (3 with tumor recurrence) at a median of 24 months' posttransplant. Rates for 1- and 3-year overall versus recurrence-free survivals were 73% and 62% versus 54% and 34%, respectively.
LDLT for HCC patients exceeding the UCSF criteria is characterized by an acceptable overall but poor recurrence-free survival. Its application requires an honest approach to donor and recipient information.
Transplantation Proceedings 12/2008; 40(9):3185-8. · 1.00 Impact Factor
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G C Sotiropoulos,
H Lang,
F H Saner,
S Beckebaum,
M Wandelt,
E P Molmenti, S Nadalin,
J Treckmann,
M Bockhorn,
I Fouzas,
M Malagó,
G Gerken,
C E Broelsch,
A Paul
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ABSTRACT: Orthotopic liver transplantation (OLT) represents the only curative treatment for end-stage liver disease, but its application is limited because of organ shortages. The purpose of this study was to review the long-term outcomes after OLT during a 2-year period of 45 rescue offers organs within Eurotransplant.
Forty-five deceased donor liver allografts had been officially offered to and rejected by other transplantation centers 162 times prior to our acceptance. Data analysis addressed recurrence of primary disease, ischemic-type biliary lesions (ITBL), re-evaluation or relisting for OLT, re-OLT, as well as overall patient and graft survivals.
Six patients underwent retransplantation because of primary nonfunction (n = 4), hepatitis C recurrence (n = 1), and secondary biliary cirrhosis following ITBL (n = 1). Five additional patients developed ITBL and received endoscopic treatment. Currently, 34 patients are alive after a median follow-up of 44.5 months. Median graft survival is 43.2 months. Patient versus patient/first graft survival at 1, 3, and 5 years is 82%, 78%, and 74%, versus 76%, 69%, and 65%, respectively.
OLT with rescue organs is a reasonable policy, with acceptable long-term patient/graft survivals, providing a real expansion of the donor pool.
Transplantation Proceedings 12/2008; 40(9):3196-7. · 1.00 Impact Factor
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A Radtke,
G Sgourakis,
G C Sotiropoulos,
E P Molmenti, S Nadalin,
I Fouzas,
T Schroeder,
F H Saner,
A Schenk,
V R Cicinnati,
M Malagó,
H Lang
[show abstract]
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ABSTRACT: The aim of this study was to analyze vascular and biliary variants at the hilar and sectorial level in right graft adult living donor liver transplantation.
From January 2003 to June 2007, 139 consecutive live liver donors underwent three-dimensional computed tomography (3-D CT) reconstructions and virtual 3-D liver partitioning. We evaluated the portal (PV), arterial (HA), and biliary (BD) anatomy.
The hilar and sectorial biliary/vascular anatomy was predominantly normal (70%-85% and 67%-78%, respectively). BD and HA showed an equal incidence (30%) of hilar anomalies. BD and PV had a nearly identical incidence of sectorial abnormalities (64.7% and 66.2%, respectively). The most frequent "single" anomaly was seen centrally in HA (21%) and distally in BD (18%). A "double" anomaly involved BD/HA (7.2%) in the hilum, and HA/PV and BD/PV (6.5% each) sectorially. A "triple" anomaly involving all systems was found at the hilum in 1.4% of cases, and at the sectorial level in 9.4% of instances. Simultanous central and distal abnormalities were rare. In this study, 13.7% of all donor candidates showed normal hilar and sectorial anatomy involving all 3 systems. A simultaneous central and distal "triple" abnormality was not encountered. A combination of "triple" hilar anomaly with "triple" sectorial normality was observed in 2 cases (1.4%). A central "triple" normality associated with a distal "triple" abnormality occurred in 7 livers (5%).
Our data showed a variety of "horizontal" (hilar or sectorial) and "vertical" (hilar and sectorial) vascular and biliary branching patterns, providing comprehensive assistance for surgical decision-making prior to right graft hepatectomy.
Transplantation Proceedings 12/2008; 40(9):3147-50. · 1.00 Impact Factor
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A Radtke,
G Sgourakis,
G C Sotiropoulos,
E P Molmenti, S Nadalin,
I Fouzas,
T Schroeder,
F Saner,
A Schenk,
V R Cincinnati,
M Malagó,
H Lang
[show abstract]
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ABSTRACT: The successful management of the bile duct in right graft adult live donor liver transplantation requires knowledge of both its central (hilar) and distal (sectorial) anatomy. The purpose of this study was to provide a systematic classification of its branching patterns to enhance clinical decision-making.
We analyzed three-dimensional computed tomography (3-D CT) imaging reconstructions of 139 potential live liver donors evaluated at our institution between January 2003 and June 2007.
Fifty-four (n = 54 or 38.8%) donor candidates had a normal (classic) hilar and sectorial right bile duct anatomy (type I). Seventy-eight (n = 78 or 56.1%) cases had either hilar or sectorial branching abnormalities (types II or III). Seven (n = 7 or 5.1%) livers had a mixed type (IV) of a rare and complex central and distal anatomy.
We believe that the classification proposed herein can aid in the better organization and categorization of the variants encountered within the right-sided intrahepatic biliary system.
Transplantation Proceedings 12/2008; 40(9):3151-4. · 1.00 Impact Factor
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A Radtke,
G Sgourakis,
G C Sotiropoulos,
E P Molmenti, S Nadalin,
I Fouzas,
T Schroeder,
F H Saner,
V R Cicinnati,
A Schenk,
M Malagó,
H Lang
[show abstract]
[hide abstract]
ABSTRACT: The peripheral intrahepatic biliary anatomy, especially at the sectorial level on the right side, has not been adequately described. The purpose of our study was to systematically describe this complex anatomy in clinically applicable fashion.
We analyzed three-dimensional computed tomography (CT) imaging reconstructions of 139 potential living liver donors evaluated at our institution between January 2003 and June 2007.
Eighty-nine (64%) donors had a normal right bile duct sectorial anatomy. In the other 50/139 (36%) cases, we observed abnormal sectorial branching patterns, with 45/50 abnormalities as trifurcations, whereas the remaining ones were quadrifurcations. In 22/50 (44%) abnormalities, a linear branching pattern (types B1/C1) and an early segmental origin off the right hepatic duct (types B3/C3) were present, a finding of particular danger when performing a right graft hepatectomy. In 2 cases, we noted a mixed type (B6/C6) of a rare complex anatomy.
Our proposed classification of the right sectorial bile duct system clearly displays the "area at risk" encountered when performing right graft adult live donor liver transplantation and tumor resections involving the right lobe of the liver.
Transplantation Proceedings 12/2008; 40(9):3158-60. · 1.00 Impact Factor
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G C Sotiropoulos,
G M Kaiser,
H Lang,
E P Molmenti,
S Beckebaum,
I Fouzas,
G Sgourakis,
A Radtke,
M Bockhorn, S Nadalin,
J Treckmann,
W Niebel,
H A Baba,
C E Broelsch,
A Paul
[show abstract]
[hide abstract]
ABSTRACT: Intrahepatic cholangiocarcinoma (ICC) is not a widely accepted indication for orthotopic liver transplantation (OLT). The present study describes our institutional experience with patients who underwent transplantation for ICC as well as those with ICC who underwent transplantation with the incorrect diagnosis of hepatocellular carcinoma (HCC).
Data corresponding to ICC patients were reviewed for the purposes of this study. Patients with hilar cholangiocarcinoma and incidentally found ICC after OLT for benign diseases were excluded from further consideration.
Among the 10 patients, 6 underwent transplantation before 1996 and 4 after 2001. Those who underwent transplantation in the early period had a preoperative diagnosis of inoperable ICC (n = 4) and ICC in the setting of primary sclerosing cholangitis (n = 2). In the latter period the subjects had a diagnosis of HCC in cirrhosis (n = 3) or recurrent ICC after an extended right hepatectomy (n = 1). Median survival was 25.3 months for the whole series and 32.2 months (range, 18-130 months) when hospital mortality was excluded (n = 3). Four patients are currently alive after 30, 35, 42, and 130 months post-OLT, respectively. Two patients died of tumor recurrence at 18 and 21 months post-OLT, respectively. One-, 3-, and 5-year survival rates were 70%, 50%, and 33%, respectively.
The role of OLT in the setting of ICC may be re-evaluated in the future under strict selection criteria and with prospective multicenter randomized studies. Potential candidates to be included are those with liver cirrhosis and no hilar involvement who meet the Milan criteria for HCC.
Transplantation Proceedings 12/2008; 40(9):3194-5. · 1.00 Impact Factor
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A Radtke, S Nadalin,
G Sgourakis,
G C Sotiropoulos,
E P Molmenti,
T Schroeder,
I Fouzas,
F H Saner,
A Schenk,
M Malagó,
H Lang
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to investigate the effect of liver compliance on computed tomography (CT) volumetry and to determine its association with postoperative small-for-size syndrome (SFSS).
Unenhanced, arterial, and venous phase CT images of 83 consecutive living liver donors who underwent graft hepatectomy for adult-to-adult living donor liver transplantation (ALDLT) were prospectively subjected to three-dimensional (3-D) CT liver volume calculations and virtual 3-D liver partitioning. Graft volume estimates based on 3-D volumetry, which subtracted intrahepatic vascular volume from the "smallest" (native) unenhanced and the "largest" (venous) CT phases, were subsequently compared with the intraoperative graft weights. Calculated (preoperative) graft volume-to-body weight ratios (GVBWR) and intraoperative measured graft weight-to-body weight ratios (GWBWR) were analyzed for postoperative SFSS.
Significant differences in minimum versus maximum total liver volumes, graft volumes, and GVBWR calculations were observed among the largest (venous) and the smallest (unenhanced) CT phases. SFSS occurred in 6% (5/83) of recipients, with a mortality rate of 80% (4/5). In four cases with postoperative SFSS (n = 3 lethal, n = 1 reversible), we had transplanted a small-for-size graft (real GWBWR < 0.8). The three SFS grafts with lethal SFSS showed a nonsignificant volume "compliance" with a maximum GVBWR < 0.83. This observation contrasts with the seven recipients with small-for-size grafts and reversible versus no SFSS who showed a "safe" maximum GVBWR of 0.92 to 1.16.
The recognition and precise assessment of each individual's liver compliance displayed by the minimum and maximum GVBWR values is critical for the accurate prediction of functional liver mass and prevention of SFSS in ALDLT.
Transplantation Proceedings 11/2008; 40(9):3142-6. · 1.00 Impact Factor
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H Lang,
G C Sotiropoulos,
S Beckebaum,
I Fouzas,
E P Molmenti,
O S Omar,
G Sgourakis,
A Radtke, S Nadalin,
F H Saner,
M Malagó,
G Gerken,
A Paul,
C E Broelsch
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to review our institutional experience with re-liver transplantation (OLT) after split and full-size OLT.
We evaluated data corresponding to retransplanted patients over an 8-year period who underwent deceased donor OLT at our institution. Variables analyzed included indications for primary OLT, and re-OLT, the type of graft used during the initial versus re-OLT, the time from initial to re-OLT, and patient survival after re-OLT.
Sixty-four of 697 first OLT (9.2%) required re-OLT. Forty-nine cases were among 637 (7.6%) full-size OLT, while 15 were among 60 (25%) split OLT (P < .001). Median time to re-OLT was 8 days (range = 1-1885 days). Main indications for re-OLT were primary nonfunction/initial poor function (44%), hepatic artery thrombosis (26%), biliary complications (11%), and hepatitis C recurrence (6%). Forty-eight percent of the re-OLTs were performed within the first posttransplant week. The overall survival for these 64 patients was 55% and 48% at 1 and 3 years after the primary OLT, and 44% at both 1 and 3 years after the re-OLT, respectively.
The overall incidence of re-OLT remains 9%. Approximately half of all re-OLT occured within the first posttransplant week. Early retransplantation was associated with the best patient survival. Overall survival after re-OLT was about 10% to 20% lower than that after primary OLT.
Transplantation Proceedings 11/2008; 40(9):3201-3. · 1.00 Impact Factor
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A Radtke,
G C Sotiropoulos, S Nadalin,
E P Molmenti,
T Schroeder,
F H Saner,
G Sgourakis,
V R Cicinnati,
C Valentin-Gamazo,
C E Broelsch,
M Malago,
Hauke Lang
[show abstract]
[hide abstract]
ABSTRACT: The precise preoperative calculation of functional liver volumes for both donor and recipient is a crucial part of the evaluation process in adult living donor liver transplantation. The purpose of this study was to describe and validate our modus 3-D CT volumetry.
Native (unenhanced), arterial, and venous phase CT images from 62 consecutive live liver donors were subjected to 3-D CT liver volume calculations and virtual 3-D liver partitioning. Graft-volume estimates based on our modus 3-D volumetry, which subtracted intrahepatic vascular volume from the "smallest" (native) unenhanced CT phase, were subsequently compared to the intraoperative graft-weights obtained in all 62 cases. Calculated (preoperative) liver-volume-body-weight-ratios and measured (intraoperative) liver-weight-body-weight-ratios of liver grafts were analyzed.
Preoperative calculations of graft-volume according to our modus 3-D CT volumetry did not yield statistically significant over- or under-estimations when compared to the intraoperative findings independent of their age or gender.
Our modus 3-D volumetry, when based on the "smallest" (native) unenhanced CT phase, accurately accounted for intrahepatic vascular volumes and offered a precise virtual model of individualized operative conditions for each potential live liver donor.
European journal of medical research 08/2008; 13(7):319-26. · 1.13 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Concomitant hepatic artery injury is a rare but severe complication associated with bile duct injury during laparoscopic cholecystectomy (LC).
Sixty patients referred with biliary injury after LC between April 1998 and December 2005 were divided into two groups according to the time elapsed between injury and definitive surgical revision; patients in group 1 were referred early (within 4 days) after operation and those in group 2 were referred later. Hepatic rearterialization was performed in addition to biliary reconstruction when technically possible.
Damage to the hepatic artery was detected in ten patients. Hepatic rearterialization was carried out in five patients by end-to-end anastomosis (one), or by using an autologous graft (three) or allogeneic vascular graft (one). Three patients in group 2 underwent right hemihepatectomy without arterial reconstruction owing to liver necrosis or lobar atrophy. Three of ten patients died from postoperative complications.
Combined bile duct and hepatic artery injury during LC led to a complicated clinical course, with a high mortality rate. Reconstruction of the right hepatic artery might be helpful in reducing hepatic ischaemia, but is usually feasible only if the injury is identified early.
British Journal of Surgery 05/2008; 95(4):460-5. · 4.61 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Sixteen years after its first successful application, living donor liver transplantation now has a small but well-established role in treatment for liver failure in Germany. It remains problematic in both child and adult patients concerning effort, expected results, and assessment of risks to the donor. Therefore the method shall remain limited to more research-oriented institutions for the time being before it can be established more broadly as an alternative to postmortal donation. In Germany it presents generally the same limitations as living donor kidney transplantation.
Der Chirurg 03/2008; 79(2):135-43. · 0.70 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Adjustment of induction therapy with Neoral after liver transplantation according to C2 levels yields a reduced incidence of rejection compared with C0 monitoring. A combination with mycophenolate mofetil may further reduce episodes of acute rejection. The purpose of this analysis was to evaluate the predictive value of C0 and C2 monitoring and the influence of primary dysfunction in liver transplant recipients receiving induction therapy with Neoral, mycophenolate mofetil, and steroids.
One hundred consecutive adult liver transplant recipients were analyzed. Neoral doses were solely adjusted according to C0 target levels in the first week by daily analysis of C0 levels. C2 levels were also measured, but results did not influence the decision process of daily Neoral adjustments.
The 3-month survival rate for all patients was 83%. For a further analysis, 35 patients were excluded, the remaining 65 patients experienced 15 rejections (23.1%). Patients who did reach C0 target levels by days 3, 5, or 7 had rejection rates no different from those who did not reach C0 target levels. The patients who did reach C2 target levels by day 7 showed a significantly lower rejection rate compared with those who did not reach these levels. Comparison of rejection rates among patients with primary function grades I and II versus grades III and IV revealed a significant difference. There was no correlation between Model for End-Stage Liver Disease (MELD) score and acute rejection episodes.
Achievement of C2 target levels by day 7, especially in the combination of Neoral with mycophenolate mofetil, led to a remarkably low acute rejection rate following liver transplantation.
Transplantation Proceedings 01/2008; 39(10):3234-6. · 1.00 Impact Factor
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American Journal of Transplantation 01/2008; 7(12):2836-7. · 6.39 Impact Factor
