J Klempnauer

Hannover Medical School, Hanover, Lower Saxony, Germany

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Publications (337)894.02 Total impact

  • Journal of Hepatology 04/2015; 62:S311. DOI:10.1016/S0168-8278(15)30257-9
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    ABSTRACT: Hydatid disease is a systemic disorder affecting especially the liver and lungs. Although it is not endemic in Europe, it can be seen sporadically, particularly because of travel and immigration. Severe, multiple organ involvement is quite rare. A 39-year-old Kurdish male patient presented with the previous diagnosis of hydatid disease and disseminated cysts in the liver, lung, and left kidney, leading to renal failure and the need for hemodialysis. Following multiple operations, complete eradication of infectious cysts was achieved, and a kidney transplantation was performed. After 4 years of follow up, the patient is in good condition, especially with normal renal function and no sign of recurrent hydatid disease. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Transplant Infectious Disease 02/2015; 17(3). DOI:10.1111/tid.12374
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    ABSTRACT: multicenter, 24-week, randomized trial investigating the effect of different once-daily, prolonged-release tacrolimus dosing regimens on renal function after de novo liver transplantation. Arm 1: prolonged-release tacrolimus (initial dose 0.2mg/kg/day); Arm 2: prolonged-release tacrolimus (0.15-0.175mg/kg/day) plus basiliximab; Arm 3: prolonged-release tacrolimus (0.2mg/kg/day delayed until Day 5) plus basiliximab. All patients received MMF plus a bolus of corticosteroid (no maintenance steroids). Primary endpoint: eGFR (MDRD4) at Week 24. Secondary endpoints: composite efficacy failure, BCAR and AEs. Baseline characteristics were comparable. Tacrolimus trough levels were readily achieved posttransplant; initially lower in Arm 2 versus 1 with delayed initiation in Arm 3. eGFR (MDRD4) was higher in Arms 2 and 3 versus 1 (p = 0.001, p = 0.047). Kaplan-Meier estimates of composite efficacy failure-free survival were 72.0%, 77.6%, 73.9% in Arms 1-3. BCAR incidence was significantly lower in Arm 2 versus 1 and 3 (p = 0.016, p = 0.039). AEs were comparable. Prolonged-release tacrolimus (0.15-0.175mg/kg/day) immediately posttransplant plus basiliximab and MMF (without maintenance corticosteroids) was associated with lower tacrolimus exposure, and significantly reduced renal function impairment and BCAR incidence versus prolonged-release tacrolimus (0.2mg/kg/day) administered immediately posttransplant. Delayed higher-dose prolonged-release tacrolimus initiation significantly reduced renal function impairment compared with immediate posttransplant administration, but BCAR incidence was comparable. © 2015 The Authors. American Journal of Transplantation published by Wiley Periodicals Inc.
    American Journal of Transplantation 02/2015; DOI:10.1111/ajt.13182
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    ABSTRACT: This study was a retrospective analysis of the European Liver Transplant Registry (ELTR) performed to compare long-term outcomes with prolonged-release tacrolimus versus tacrolimus BD in liver transplantation (January 2008-December 2012). Clinical efficacy measures included univariate and multivariate analyses of risk factors influencing graft and patient survival at 3 years posttransplant. Efficacy measures were repeated using propensity score-matching for baseline demographics. Patients with <1 month of follow-up were excluded from the analyses. In total, 4367 patients (prolonged-release tacrolimus: n = 528; BD: n = 3839) from 21 European centers were included. Tacrolimus BD treatment was significantly associated with inferior graft (risk ratio: 1.81; p = 0.001) and patient survival (risk ratio: 1.72; p = 0.004) in multivariate analyses. Similar analyses performed on the propensity score-matched patients confirmed the significant survival advantages observed in the prolonged-release tacrolimus- versus tacrolimus BD-treated group. This large retrospective analysis from the ELTR identified significant improvements in long-term graft and patient survival in patients treated with prolonged-release tacrolimus versus tacrolimus BD in primary liver transplant recipients over 3 years of treatment. However, as with any retrospective registry evaluation, there are a number of limitations that should be considered when interpreting these data. © 2015 The Authors. American Journal of Transplantation Published by Wiley Periodicals, Inc.
    American Journal of Transplantation 02/2015; 15(XX):1-16. DOI:10.1111/ajt.13171
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    ABSTRACT: Hepatitis C is the leading indication for liver transplantation. Differentiation between recurrent graft hepatitis C (RGH-C) and graft rejection (GR) is challenging. Liver biopsy is standard to diagnose both conditions; however, little information is available regarding this procedure in hepatitis C virus (HCV)-infected liver transplant recipients.
    Transplant Infectious Disease 11/2014; DOI:10.1111/tid.12310
  • Zeitschrift für Gastroenterologie 08/2014; 52(08). DOI:10.1055/s-0034-1386121
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    ABSTRACT: Abdominal complications after thoracic transplantation (Tx) are potentially associated with an increased risk of mortality. We recently reported about the severe outcome after bowel perforation in patients following lung transplantation (LuTx). The aim of the present study was to likewise identify the risk factors with an impact on patient survival following heart transplantation (HTx). A retrospective analysis for the frequency and outcome of abdominal interventions following HTx was performed in 342 patients, and these data thereafter compared to a re-evaluated pool of 1,074 patients following LuTx. All patients were transplanted at Hanover Medical School, Germany, between January 2000 and October 2011. The incidence for abdominal surgery was comparable between patients following HTx (n = 33; 9.6 %) and LuTx (n = 90; 8.4 %). Elective operations were more frequently performed in patients after HTx (8.5 vs. 5.1 %). In contrast, the incidence of emergency interventions was higher after LuTx (5.3 %) than that following HTx (2.3 %). Herewith associated was the mortality observed in these transplant recipients (15.3 and 9.9 % for LuTx and HTx, respectively). Leading diagnosis for emergency surgery was bowel perforation (n = 18, regarding all cases). In 11 of these patients, perforation occurred within the first 6 months after Tx and eight of them died in the course of this complication (one patient after HTx and seven patients after LuTx). Abdominal complications after HTx are less frequently than after LuTx but equally correlate with a high mortality rate. In finding or even reasonable suspicion of an acute abdomen after thoracic Tx, a broad practice for extended diagnostics and a low barrier for an early explorative laparotomy thus are recommended.
    Langenbeck s Archives of Surgery 04/2014; 399(6). DOI:10.1007/s00423-014-1193-7
  • J. Klose, M. Klose, M. Manns, J. Klempnauer, H. Schrem
    Journal of Hepatology 04/2014; 60(1):S361. DOI:10.1016/S0168-8278(14)61025-4
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    ABSTRACT: HCV RNA levels correlate with the long-term outcome of hepatitis C in liver transplant recipients. Nucleic acid testing (NAT) is usually used to confirm HCV reinfection and to examine viral loads after liver transplantation. HCV core antigen (HCVcoreAg) testing could be an alternative to NAT with some potential advantages including very low intra- and interassay variabilities and lower costs. The performance of HCVcoreAg testing in organ transplant recipients is unknown. We prospectively studied 1011 sera for HCV RNA and HCVcoreAg in a routine real-world setting including 222 samples obtained from patients after liver or kidney transplantation. HCV RNA and HCVcoreAg test results showed a consistency of 98% with a very good correlation in transplanted patients (r > 0.85). The correlation between HCV RNA and HCVcoreAg was higher in sera with high viral loads and in samples from patients with low biochemical disease. Patients treated with tacrolimus showed a better correlation between both parameters than individuals receiving cyclosporine A. HCV RNA/HCVcoreAg ratios did not differ between transplanted and nontransplanted patients, and HCV RNA and HCVcoreAg kinetics were almost identical during the first days after liver transplantation. HCVcoreAg testing can be used to monitor HCV viral loads in patients after organ transplantation. However, the assay is not recommended to monitor antiviral therapies.
    Journal of Viral Hepatitis 11/2013; 21(11). DOI:10.1111/jvh.12204
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    ABSTRACT: The interdisciplinary guidelines at the S3 level on the diagnosis of and therapy for hepatocellular carcinoma (HCC) constitute an evidence- and consensus-based instrument that is aimed at improving the diagnosis of and therapy for HCC since these are very challenging tasks. The purpose of the guidelines is to offer the patient (with suspected or confirmed HCC) adequate, scientifically based and up-to-date procedures in diagnosis, therapy and rehabilitation. This holds not only for locally limited or focally advanced disease but also for the existence of recurrences or distant metastases. Besides making a contribution to an appropriate health-care service, the guidelines should also provide the foundation for an individually adapted, high-quality therapy. The explanatory background texts should also enable non-specialist but responsible colleagues to give sound advice to their patients concerning specialist procedures, side effects and results. In the medium and long-term this should reduce the morbidity and mortality of patients with HCC and improve their quality of life.
    Zeitschrift für Gastroenterologie 11/2013; 51(11):1269-326.
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    ABSTRACT: The interdisciplinary guidelines at the S3 level on the diagnosis of and therapy for hepatocellular carcinoma (HCC) constitute an evidence- and consensus-based instrument that is aimed at improving the diagnosis of and therapy for HCC since these are very challenging tasks. The purpose of the guidelines is to offer the patient (with suspected or confirmed HCC) adequate, scientifically based and up-to-date procedures in diagnosis, therapy and rehabilitation. This holds not only for locally limited or focally advanced disease but also for the existence of recurrences or distant metastases. Besides making a contribution to an appropriate health-care service, the guidelines should also provide the foundation for an individually adapted, high-quality therapy. The explanatory background texts should also enable non-specialist but responsible colleagues to give sound advice to their patients concerning specialist procedures, side effects and results. In the medium and long-term this should reduce the morbidity and mortality of patients with HCC and improve their quality of life.
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    ABSTRACT: Bei Gurtmarken am Abdomen muss auch an eine mögliche Bauchwandzerreißung gedacht werden. Die FAST-Sonographie und das Traumascan-CT stellen bei kreislaufstabilen Patienten mit Gurtmarken das Diagnostikum der Wahl dar. Aufgrund des Unfallmechanismus können zusätzliche intraabdominelle Verletzungen, Wirbelsäulenverletzungen und Aortenrupturen vorliegen. Bauchwandverletzungen ab Grad IV nach Dennis sollten chirurgisch versorgt werden. Aufgrund der zunehmenden Zahl adipöser Insassen und deren spezieller Verletzungsrisiken könnten aktive Rückhaltesysteme, neben der korrekten Positionierung das Verletzungsrisiko reduzieren.
    Der Unfallchirurg 10/2013; 117(10). DOI:10.1007/s00113-013-2493-z
  • Zeitschrift für Gastroenterologie 08/2013; 51(08). DOI:10.1055/s-0033-1353058
  • Zeitschrift für Gastroenterologie 08/2013; 51(08). DOI:10.1055/s-0033-1353060
  • Zeitschrift für Gastroenterologie 08/2013; 51(08). DOI:10.1055/s-0033-1352756
  • Zeitschrift für Gastroenterologie 08/2013; 51(08). DOI:10.1055/s-0033-1352744
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    ABSTRACT: Abdominal seat belt marks can be an indication of abdominal wall rupture. The focused assessment with sonography for trauma (FAST) and computed tomography (CT) scanning are the diagnostic tools of choice in hemodynamically stable patients. The typical mechanism of trauma frequently leads to additional intra-abdominal injuries, spinal injuries and in some cases aortic rupture. Abdominal wall injuries of grade IV according to Dennis should be surgically treated. The increasing numbers of obese vehicle occupants and the resulting special risk of injury warrant optimization of technical restraint systems.
    Der Unfallchirurg 07/2013;
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    ABSTRACT: Background and study aim: Placement of covered self-expanding metal or plastic stents (SEMS or SEPS) is an established method for managing intrathoracic leaks. Recently, endoscopic vacuum-assisted closure (EVAC) has been described as a new effective treatment option. Our aim was to compare stent placement with EVAC for nonsurgical closure of intrathoracic anastomotic leaks.Patients and methods: In a retrospective analysis we were able to identify 39 patients who were treated with SEMS or SEPS and 32 patients who were treated with EVAC for intrathoracic leakage. In addition to successful fistula closure, we analyzed hospital mortality, number of endoscopic interventions, incidence of stenoses, and duration of hospitalization. Results: In a multivariate analysis, successful wound closure was independently associated with EVAC therapy (hazard ratio 2.997, 95 % confidence interval [95 %CI] 1.568 - 5.729; P = 0.001). The overall closure rate was significantly higher in the EVAC group (84.4 %) compared with the SEMS/SEPS group (53.8 %). No difference was found for hospitalization and hospital mortality. We found significantly more strictures in the stent group (28.2 % vs. 9.4 % with EVAC, P < 0,05). Conclusions: EVAC is an effective endoscopic treatment option for intrathoracic leaks and showed higher effectiveness than stent placement in our cohort.
    Endoscopy 06/2013; 45(6):433-8. DOI:10.1055/s-0032-1326435
  • U Kulik, H Bektas, J Klempnauer, F Lehner
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    ABSTRACT: Following resection of colorectal liver metastases (CLMs) up to 75 per cent of patients develop recurrent liver metastases. Although repeat resection remains the only curative therapy, data evaluating the outcome are deficient. This study analysed postoperative morbidity, mortality and independent predictors of survival following repeat resection of CLMs. Data on surgical treatment of primary and recurrent CLMs between 1994 and 2010 were collected retrospectively, and compared with those for single hepatic resections carried out during the same period. Independent predictors of survival were evaluated by means of univariable and multivariable Cox regression models. In this interval 1026 primary resections of CLMs were performed and 94 patients underwent repeat CLM excision. Overall postoperative morbidity and mortality rates were low (15·8 and 1·3 per cent respectively), with no statistical difference in patients undergoing repeat surgery (P = 0·072). Compared with single liver resections, overall survival was improved in repeat resections (P = 0·003). Multivariable analysis revealed that size of primary CLM over 50 mm was an independent predictor of survival (hazard ratio (HR) 2·61; P = 0·008). Only major hepatic resection was associated with poorer outcome following repeat surgery (HR 2·62; P = 0·009). International Union Against Cancer stage, number of CLMs, age at surgery and need for intraoperative transfusion had no impact on survival after repeat resection. Recurrent CLM surgery is feasible with similar morbidity and mortality rates to those of initial or single CLM resections.
    British Journal of Surgery 06/2013; 100(7):926-32. DOI:10.1002/bjs.9132
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    ABSTRACT: Background: Survival of critically ill patients is significantly affected by prolonged ventilation. The goal of this study was the development of a Respiratory Risk Score (RRS) for the prediction of 3-month mortality and prolonged ventilation following liver transplantation. Methods: 254 consecutive liver transplant patients from a single center were retrospectively randomized into a training group for model design and a validation group. ROC-curve analysis was used to test sensitivity and specificity. Accuracy of prediction was assessed with the Brier-score and model calibration with the Hosmer-Lemeshow-test. Cut-off values were determined with the best Youden-Index. Results: The RRS was calculated in the first 24 hours as follows: (lab-MELD-score>30 = 2.36 points) + (fresh frozen plasma units>13 = 2.70 points) + (PaO2/FiO2 ratio <200mmHg = 2.23 points) + (packed red blood cells>10 = 3.50 points) + (pre-operative mechanical ventilation = 3.87 points) + (pre-operative dialysis = 2.83 points) + (donor steatosis hepatis>40% = 2.95 points). The RSS demonstrated high accuracy of prediction, good model calibration and c-statistics >0.7 in the training group and validation group. The RSS is able to predict 3-month mortality (cut-off 6.64; area under the ROC-curve (AUROC) 0.794) and prolonged ventilation (cut-off 3.69; AUROC 0.798) with a sensitivity of 69% and 81%, a specificity of 83% and 73% and an overall model correctness of 76% and 77%, respectively. Conclusions: This study provides the first prognostic model for the prediction of 3-month mortality and prolonged ventilation after liver transplantation with high sensitivity, specificity, and good model accuracy. Application of the RRS on an external cohort would be desirable for its further validation and introduction as a clinical tool for intensive care resource planning and prognostic decision making. Liver Transpl, 2013. © 2013 AASLD.
    Liver Transplantation 05/2013; DOI:10.1002/lt.23673.

Publication Stats

3k Citations
894.02 Total Impact Points

Institutions

  • 1989–2014
    • Hannover Medical School
      • • Clinic for General, Abdominal and Transplant Surgery
      • • Department of Gastroenterology, Hepatology and Endocrinology
      • • Institute for Pathology
      Hanover, Lower Saxony, Germany
  • 1994–2009
    • Hochschule Hannover
      Hanover, Lower Saxony, Germany
  • 2006
    • Hôpital Paul-Brousse – Hôpitaux universitaires Paris-Sud
      Villejuif, Île-de-France, France
  • 2004
    • Heinrich-Heine-Universität Düsseldorf
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2001
    • University of Hamburg
      • Department of Pathology
      Hamburg, Hamburg, Germany
  • 2000
    • German Primate Center
      Göttingen, Lower Saxony, Germany
  • 1998–1999
    • Ruhr-Universität Bochum
      Bochum, North Rhine-Westphalia, Germany
  • 1997
    • Städtisches Krankenhaus Kiel
      Kiel, Schleswig-Holstein, Germany