G Testa

Imperial College London, London, ENG, United Kingdom

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Publications (20)30.07 Total impact

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    ABSTRACT: A 63-year-old woman underwent living donor liver transplantation for hepatic metastases of an extragastrointestinal stromal tumor (EGIST) originating from the rectovaginal space. Due to a multifocal extrahepatic tumor recurrence, treatment with imatinib mesylate was started after extensive pharmacokinetic studies to rule out possible interactions with immunosuppressives. We performed several re- resections for EGIST recurrence thereafter. At the last follow-up, 17 years after primary tumor resection and 10 years after living donor liver transplantation, the patient is symptom-free under immunosuppressive and imatinib mesylate treatments with a 2-cm stable recurrent pararectal EGIST. To our knowledge, this is the only report published on a patient who underwent transplantation for hepatic EGIST metastases with a posttransplantation follow-up of 10 years and the first report on living donor liver transplantation for metastasized EGIST. This is the first description of pharmacokinetics of imatinib and its main active metabolite CGP74588 in a liver transplant recipient.
    Transplantation Proceedings 11/2010; 42(9):3843-8. · 0.95 Impact Factor
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    ABSTRACT: The outcomes of 19 consecutive living-donor renal transplants (LD-RTx) was compared with 41 cadaveric grafts (CD-RTx) performed at our institution using basiliximab, cyclosporine, and prednisone as standard immunosuppression. LD-RTx significantly shortened the waiting time on dialysis. However, patient survival (100% in both groups), 1-year graft survival (94.7% vs 90%), and rejection-free graft survival (76.9% vs 73.5%) was not significantly different. LD-RTx showed better glomerular filtration rates in the early phase after transplantation, a difference that faded with time. Graft function was similar after 1 and 2 years. LD grafts with double renal arteries were used successfully in four cases; heparin therapy was administered to avoid graft thrombosis. A significantly greater number of lymphoceles was observed with LD grafts (7/19 vs 1/41, P < .01). In conclusion with improved immunosuppression producing better results with CD grafts, the advantages of LD-RTx have vanished. LD grafts with double arteries may be used successfully and LD-RTx allows a shorter dialysis period. The high incidence of lymphoceles in our series awaits further evaluation.
    Transplantation Proceedings 06/2004; 36(5):1308-10. · 0.95 Impact Factor
  • Transplantation Proceedings 06/2003; 35(3):953-4. · 0.95 Impact Factor
  • Transplantation Proceedings 07/2002; 34(4):1229-30. · 0.95 Impact Factor
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    ABSTRACT: There are more than 15,000 patients waiting for a liver transplant in the USA, with an average waiting time of 468 days and a mortality rate as high as 15-20%. Until artificial organs or xenotransplantation becomes a reality, living donor liver transplantation remains the best option for patients with end stage liver disease.
    Gut 03/2002; 50(2):143-5. · 10.73 Impact Factor
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    ABSTRACT: Living-related liver transplantation is a successful clinical approach to overcome organ shortage in hepatic transplantation. Possible advantages for the recipient of a living-donor transplant are a much shorter waiting period until transplantation and an almost elective time of operation which results in a decreased operative risk. Furthermore graft function of a living-related transplant is better than in cadaveric transplantation because of the shorter ischemic time and a careful examination of graft quality before organ donation. Removal of even more than 50 % of liver volume during the donor operation does not lead to an impairment of liver function in the organ donor. Intraoperative blood loss can usually be managed by re-transfusion of donor's own blood. Postoperative morbidity is about 10 - 15 % depending on the extent of the removed liver lobe. Most frequent postoperative complications are biliary leckages, wound infections and gastric/duodenal ulcerations. Up till now in more than 1000 living-related liver donations only three deaths occured due to thromboembolic and septic complications (< 0,3 %) (until 12/1998).
    PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie 12/2001; 51(12):447-51. · 1.02 Impact Factor
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    ABSTRACT: Summary Human liver transplantation is still hampered by lack of suitable donor organs. Many patients die on the waiting list. In addition, preservation and reperfusion injury are still acute problems in liver transplantation, especially with long preservation times. This article focuses on possible avenues to improve organ quality. Studies showed that rapid cooling of the liver during retrieval is important, thus resulting in low enzyme release upon reperfusion. Also, the effect of the hydrophilic bile salt tauroursodeoxycholate upon reperfusion injury was tested. It is shown that after pig liver transplantation, enzyme release and bile flow are improved, and the structural integrity of the biliary system is preserved. These results indicate that special treatment and pre-conditioning of the donor liver could lead to improved organ function and decreased numbers of organs with primary dysfunction or even nonfunction. Zusammenfassung Bei der Lebertransplantation ist der Mangel an Spenderorganen das letztendlich limitierende Problem, die vielen Patienten auf der Warteliste ausreichend zu versorgen. Hinzu kommt, dass die Prservations- und Reperfusionsschdigung der Spenderleber ein noch unzureichend gelstes Problem bei der Lebertransplantation ist, v.a. wenn die Konservierungszeit ber 12h hinausgeht. In diesem Artikel werden Ergebnisse einer mglichen Konditionierung der Spenderleber vorgestellt. Zum einen zeigt sich, dass eine optimale Khlung der Organe whrend der Entnahme wichtig ist, zum anderen kann durch das in der inneren Medizin seit langem bekannte hydrophile Gallensalz Ursodeoxycholat eine Reperfusionsschdigung abgemildert werden: Die Enzymfreisetzung nach Reperfusion ist vermindert, zudem sind Gallenfluss und Gallensalzsekretionsrate signifikant gesteigert. Fr die Klinik bedeuten diese Ergebnisse, dass durch eine gezielte Behandlung der Leber vor Entnahme eine Qualittssteigerung erzielt werden kann, die in groen Kolleketiven auch zu einer signifikanten Senkung der Raten von initialer Funktionsstrung (primary dysfunction) und initialem Nichtfunktionieren (primary nonfunction) fhren sollte. Groe klinische Studien fehlen hierzu jedoch noch.
    Intensivmedizin + Notfallmedizin 10/2001; 38(9):I71-I82.
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    ABSTRACT: The insufficient number of suitable cadaveric organs for pediatric recipients is the cause of high pretransplant mortality rates and long waiting times. With the introduction of split and living related liver transplantation, the waiting list mortality rate has dropped from greater than 15% to less than 5% and children are transplanted more rapidly. A 5-year patient and graft survival rate of greater than 80% has been obtained in those centers where split and living related liver transplantations are routinely performed. The data analyzed in this paper show that the only current solution to cadaveric organ shortage is a 'multimodal' approach, where whole liver cadaveric transplantation is associated with split and living related liver transplantation.
    Pediatric Transplantation 03/2001; 5(1):16-20. · 1.50 Impact Factor
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    ABSTRACT: Most liver tumors can be removed with conventional resection techniques employing partial or total vascular occlusion when needed. Duration of tolerable warm ischemia has not yet been defined, but it seems to be well tolerated up to 60 min. In a few cases with extended vascular resection and reconstruction liver protection by hypothermic perfusion is advantageous. This can be achieved by in situ perfusion, ante situm resection or ex situ resection. Major reconstruction of hepatic vessels with good technical access should be performed under in situ hypothermic protection using veno-venous bypass. Tumors involving the hepatic venous confluence and/or retrohepatic vena cava should be approached by either the in situ, or preferentially, the ante situm resection technique. The indication for an ex situ liver resection resulting in autotransplantation of the remnant liver exists only in rare cases for oncological reasons.
    Der Chirurg 03/2001; 72(2):131-7. · 0.52 Impact Factor
  • Journal of Hepatology - J HEPATOL. 01/2001; 34:50-50.
  • Chirurg. 01/2001; 72(2):131-137.
  • Journal of Hepatology - J HEPATOL. 01/2001; 34:8-8.
  • Psychotherapie Psychosomatik Medizinische Psychologie - PSYCHOTHER PSYCHOSOM MED PSYC. 01/2001; 51(12):447-451.
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    ABSTRACT: Die meisten Lebertumore können durch konventionelle Resektionsverfahren sowie unter zusätzlicher partieller oder totaler vasculärer Occlusion der Leber entfernt werden. Die hierbei tolerierbare normotherme Ischämiezeit liegt für die nicht-cirrhotische Leber bei etwa 60 Min. In wenigen Fällen, bei denen auch ausgedehnte Gefäßresektionen und -rekonstruktionen vorgenommen werden müssen, sind Operationen an der hypotherm perfundierten Leber vorteilhaft und sinnvoll. Hierfür stehen in situ, ante situm oder ex situ Resektionen zur Verfügung. Eine Indikationen zur Resektion an der in situ perfundierten Leber ist gegeben, wenn Ischämiezeiten zur Resektion und Rekonstruktion notwendig sind, die über die normale warme Ischämietoleranz hinausgehen. Insbesondere bei Tumoren im Bereich des Lebervenenkonfluens und/oder der retrohepatischen V. cava ist eine ante situm Resektion in Erwägung zu ziehen. Die ex situ Resektion mit anschließender Autotransplantation ist nur in wenigen Ausnahmefällen indiziert. Most liver tumors can be removed with conventional resection techniques employing partial or total vascular occlusion when needed. Duration of tolerable warm ischemia has not yet been defined, but it seems to be well tolerated up to 60 min. In a few cases with extended vascular resection and reconstruction liver protection by hypothermic perfusion is advantageous. This can be achieved by in situ perfusion, ante situm resection or ex situ resection. Major reconstruction of hepatic vessels with good technical access should be performed under in situ hypothermic protection using veno-venous bypass. Tumors involving the hepatic venous confluence and/or retrohepatic vena cava should be approached by either the in situ, or preferentially, the ante situm resection technique. The indication for an ex situ liver resection resulting in autotransplantation of the remnant liver exists only in rare cases for oncological reasons.
    Der Chirurg 01/2001; 72(2):131-137. · 0.52 Impact Factor
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    ABSTRACT: 1. Eleven European centers have performed 228 living donor liver transplants (LDLT): 105 in children and 123 in adults. 2. Right lobe donation was used in 111 of 123 adult cases (90%). 3. There was 1 donor death ( approximately 0.8%), and 17.8% of donors experienced significant complications. 4. Eighty-six percent of recipients and 83% of grafts survived. Biliary complications occurred in 14.6%.
    Liver Transplantation 12/2000; 6(6 Suppl 2):S64-5. · 3.94 Impact Factor
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    ABSTRACT: Since the introduction of adult-to-adult living donor liver transplantation using the right lobe of the liver, biliary problems have led the list of complications resulting in postoperative morbidity. We report our experience with the first 30 living donor liver transplantations performed in our institution from August 1998 to January 2000. Patients were 21 men and 9 women, with a mean age 45 +/- 16 years. Mean recipient weight was 65.1 +/- 17.9 kg, mean graft weight was 877 +/- 146 g, and the mean graft-recipient weight ratio was 1.5 +/- 0.6. Patient and graft survival rates were 83.3% and 80%, respectively. Biliary anastomosis was either an end-to-end hepaticocholedochostomy with a T-drain or hepaticojejunostomy. Mean follow-up was 217.4 +/- 149.8 days. The overall complication rate was 26.6% (8 of 30 procedures) and was directly correlated to the type of anastomosis and number of bile ducts. Surgical revision was necessary in all cases. Biliary complications were not the primary cause of graft loss. Adult living donor liver transplantation using the right lobe is a successful procedure, with graft and patient survival similar to those in cadaver full-organ transplantation. Postoperative morbidity, mainly caused by biliary leak, was directly related to the number of ducts and type of anastomosis. With increasing experience, we have better defined our plane of transection on the hilar plate, with the goal of obtaining only 1 biliary duct for the anastomosis. We also improved our parenchymal transection technique, which resulted in a decreased incidence of leak at the cut-surface area.
    Liver Transplantation 12/2000; 6(6):710-4. · 3.94 Impact Factor
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    ABSTRACT: Liver transplantation is associated with a great risk of bleeding, which is of both surgical and medical etiopathogenesis. All phases of the transplantation are characterized by a complicated and continuously evolving derangement of pro- and anticoagulant factors, which result in coagulopathy. The magnitude of this coagulopathy varies between patients and therefore must be corrected on an individual basis. During the different phases of the transplantation, treatment must be targeted with the aim of controlling the bleeding according to its pathogenesis. This paper analyzes the problems associated with the monitoring and correction of coagulation during the different phases of liver transplantation, with specific focus on the idiosyncrasies of segmental liver transplantation.
    Blood Coagulation and Fibrinolysis 05/2000; 11 Suppl 1:S81-5. · 1.25 Impact Factor
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    ABSTRACT: End-stage liver disease is being treated by liver transplantation. Despite legislative and social efforts, the number of cadaveric organs suitable for liver transplantation has not grown to match the increasing demand. The insufficient number of grafts results in high mortality for patients on the waiting list and prolonged waiting times with increasing morbidity. Following the success of living related-donor segmental liver transplantation in children, an amended concept has been applied to the adult patients. The early experience with this technique, the process concerning the selection of the donor for the recipient, the risks of the donor, and the future evolution of living related-donor liver transplantation are the topics of this article.
    Langenbeck s Archives of Surgery 01/2000; 384(6):536-43. · 1.89 Impact Factor
  • Journal of Hepatology - J HEPATOL. 01/2000; 32:27-27.
  • Transplantation Proceedings 33(1-2):1504. · 0.95 Impact Factor

Publication Stats

317 Citations
30.07 Total Impact Points

Institutions

  • 2010
    • Imperial College London
      • Department of Surgery and Cancer
      London, ENG, United Kingdom
  • 2000–2003
    • University Hospital Essen
      • Klinik für Allgemeinchirurgie, Viszeral- und Transplantationschirurgie
      Essen, North Rhine-Westphalia, Germany
    • University of Duisburg-Essen
      Essen, North Rhine-Westphalia, Germany