Jens Gunther Brockmann

• Prof. Dr. med.
• Consultant Surgeon at King Faisal Specialist Hospital and Research Centre

Guidelines for pancreas transplantation became first available in 2021 in the form of recommendations generated by a group of experts at a world conference [1]. Their main message was that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone (PTA) can improve long-term survival, and all types of pancreas transp...

Die Organisation der Organentnahme obliegt in Deutschland der Deutschen Stiftung Organtransplantation (DSO). Voraussetzung für die Einleitung des postmortale Organspendeprozesses und konsekutiv der Organentnahme ist die zweifelsfreie Feststellung des irreversiblen Hirnfunktionsausfalls (IHA, „Hirntod“) sowie die Einwilligung der Spenderin bzw. des...

Purpose Atypical variants of the hepatic artery are common and pose a technical challenge for normothermic machine perfusion (NMP). The transplant surgeon has three options when confronted with hepatic arterial variation in a liver graft to be subjected to NMP: to perform arterial reconstruction (i) prior, (ii) during, or (iii) following NMP. Meth...

In liver transplantation, older donor age is a well-known risk factor for dismal outcomes, especially due to the high susceptibility of older grafts to ischemia-reperfusion injury. However, whether the factors correlating with impaired graft and patient survival following the transplantation of older grafts follow a linear trend among elderly donor...

Ischemia reperfusion injury (IRI) is a form of sterile inflammation whose severity determines short- and long-term graft fates in kidney transplantation. Neutrophils are now recognized as a key cell type mediating early graft injury, which activates further innate immune responses and intensifies acquired immunity and alloimmunity. Since the macrol...

The term intestinal failure (IF) is understood as the transient or irreversible loss of the resorptive capacity of the bowels. This includes a multitude of diseases, some of which have anatomical causes and others functional causes. The functional capacity (absorption and motility) of the remaining digestive tract and the bacterial overgrowth and f...

Organ scarcity demands critical decision-making regarding eligible transplant candidates and graft allocation to ensure best benefit from renal transplantation (RTx). Among the controversial relative contraindications is a history of pretransplant malignancy (PTM). While oncological outcomes of PTM-RTx recipients are well described, data on graft-s...

Background Although most centers perform primary portal vein reperfusion (PV) in orthotopic liver transplantation (OLT) for historical reasons, there is so far no sound evidence as to whether this technique is superior. The present study evaluated the long-term outcome of 3 different reperfusion sequences: PV vs primary arterial (A) vs simultaneous...

First year experience of liver graft normothermic machine perfusion at University hospital Münster F. Kneifel1, I. Flammang1, F. Becker1, T. Vogel1, S. Radünz,1 P. Houben1, H. Schmidt2, A. Pascher1, J.G. Brockmann1 1 Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany 2 Department of Medicine B,...

Background Transplant recipients are at high risk for infections. However, donor-recipient transmission of multidrug-resistant organisms (MDROs) remains mostly unaddressed in the protocols of pre-transplant infection and colonization screening. Vancomycin-resistant enterococci (VRE) are MDROs that colonize the gastrointestinal tract and are associa...

To ameliorate ischemia-induced graft injury, optimal organ preservation remains a critical hallmark event in solid organ transplantation. Although numerous preservation solutions are in use, they still have functional limitations. Here, we present a concise review of a modified Histidine-Tryptophan-Ketoglutarate (HTK) solution, named HTK-N. Its com...

Objective: The aim of this study was to evaluate the survival benefit of sirolimus in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC) (exploratory analysis of the SiLVER-trial). Summary and background data: Patients receiving LT) for HCC are at a high risk for tumor recurrence. Calcineurin inhibitors have shown...

A human immunodeficiency virus (HIV) infection is no longer an absolute contraindication for solid organ transplantation, yet such a setting is still challenging and little explored because of general reservations and medical difficulties. We describe a 51-year-old man with end-stage renal failure due to polycystic kidney disease who underwent an A...

Intestinal ischemia reperfusion injury (IRI) is an inherent, unavoidable event of intestinal transplantation, contributing to allograft failure and rejection. The inflammatory state elicited by intestinal IRI is characterized by heightened leukocyte recruitment to the gut, which is amplified by a cross-talk with platelets at the endothelial border....

Machine perfusion will become established as the standard of care for solid organ transplantation in the near future. Ongoing studies are investigating the appropriate perfusion algorithms for each specific organ. Although it is neither proven which perfusion principle nor type of device is superior, it has already been sufficiently shown that the...

Background and Aims The organ shortage especially in blood group 0 forces transplant professionals to discuss new approaches to expand the donor pool. Recently, the successful therapy of HCV with direct antiviral agents in kidney transplanted patients has made the transplantation of HCV-infected kidneys to uninfected patients possible. Furthermore,...

The aim of this study was to analyze the value of urine α- and π-GST in monitoring and predicting kidney graft function following transplantation. In addition, urine samples from corresponding organ donors was analyzed and compared with graft function after organ donation from brain-dead and living donors. Urine samples from brain-dead (n = 30) and...

Background Sleep deprivation is a well-known risk factor for the performance of medical professionals. Solid organ transplantation (especially orthotopic liver transplantation (oLT)) appears to be vulnerable since it combines technically challenging operative procedures with an often unpredictable start time, frequently during the night. Aim of thi...

Although the outcomes of ABO-incompatible (ABOi) kidney transplant recipients are quite favorable, these patients are at increased risk of early antibody-mediated rejection (AMR) and graft loss. Some studies have also shown high mortality in the ABOi group mainly due to increased risk of infections. The AMR rates have been reported anywhere from <1...

Background: A significant gap exists between demand and supply of organs for patients with end-stage renal disease. To increase the donor pool, kidney transplantation is performed across ABO- and HLA-incompatible barriers. ABO-incompatible kidney transplant (ABOi-KT) recipients are at increased risk of antibody-mediated rejection, infection, and mo...

Solid organ transplantation (SOT) following haematopoietic cell transplantation (HCT) is a rare event. Uncertainty exists whether such recipients are at higher risk of relapse of underlying haematological disease or at increased risk of developing infectious or immunological complications and malignancies following SOT. The experience at our referr...

Background: Histological evaluation of the pancreas graft is usually done on demand resulting in significant delays. This analysis reports on endoscopic protocol duodenal graft biopsies at regular intervals to determine feasibility, safety and monitoring benefits. Methods: Protocol duodenal graft biopsies in 27 18 consecutive pancreas transplant...

Background: Living-donor nephrectomy (LDN) is challenging, as surgery is performed on healthy individuals. Minimally invasive techniques for LDN have become standard in most centers. Nevertheless, numerous techniques have been described with no consensus on which is the superior approach. Both hand-assisted retroperitoneoscopic (HARS) and hand-ass...

Current cold storage organ preservation technique fails to preserve marginal donor grafts sufficiently. Evidence from large animal experiments suggests superiority of normothermic machine preservation of liver allografts. Long-term organ preservation using normothermic perfusion might not only allow organ viability assessment before transplantation...

Aim Sensitization events such as blood product transfusion, pregnancy and transplantation can change the HLA antibody profile of patients in its specificity and strength. Here we report a case of HLA class I and II negative antibody screened patient who received a kidney and within only 10 days of transplant was tested crossmatch positive with panc...

Classical split liver transplantation has proved a successful means of transplanting children with size-matched organs without reducing the adult cadaveric liver pool. However, the conventional technique of liver splitting after retrieval (ex situ) implies either increasing the ischaemia time of one graft or the logistic problems of simultaneous tr...

Living kidney donation is safe and established, but can lead to long-term complications such as chronic fatigue. Since the adrenal vein is usually transected during left-sided donor nephrectomy - which is not necessary on the right- we hypothesized that venous congestion might lead to an impairment of adrenal function, offering a possible explanati...

Donor organ shortage necessitates use of less than optimal donor allografts for transplantation. The current cold storage preservation technique fails to preserve marginal donor grafts sufficiently. Evidence from large animal experiments suggests superiority of normothermic machine preservation (NMP) of liver allografts. In this study, we analyze d...

We conducted an open-label, prospective, randomized trial to assess the efficacy and safety of RANKL inhibition with denosumab to prevent the loss of BMD in the first year after kidney transplantation. Ninety kidney transplant recipients were randomized 1:1 two weeks after surgery to receive denosumab (60 mg at baseline and 6 months) or no treatmen...

Background: We investigated whether sirolimus-based immunosuppression improves outcomes in liver transplantation (LTx) candidates with hepatocellular carcinoma (HCC). Methods: In a prospective-randomized open-label international trial, 525 LTx recipients with HCC initially receiving mammalian target of rapamycin inhibitor-free immunosuppression...

Background: Kidney transplantation has long been recognized as the best available therapy for end stage kidney disease. Objectives: This study aimed to compare outcomes of double-J versus percutaneous ureteral stent placement in renal transplantation. Patients and methods: A retrospective analysis was performed on data of renal transplantation...

There is limited clinical evidence on the utility of the monitoring of Epstein Barr virus (EBV) DNAemia in the preemptive management of post-transplant lymphoproliferative disease (PTLD) in solid organ transplant (SOT) recipients. We investigated current preventive measures against EBV-related PTLD through a web-based questionnaire sent to 669 SOT...

OBJECTIVE: In patients with type 1 diabetes and end-stage renal disease, combined transplantation of a kidney together with a pancreas or isolated pancreatic islets are options to improve glycemic control. The aim of this study was to compare their long-term outcome with regard to metabolic control and surgical complication rate, as well as functio...

BACKGROUND/AIMS: Sclerostin is secreted by osteocytes. As a circulating inhibitor of the Wnt-signaling pathway it inhibits bone formation and contributes to the development of osteoporosis. Sclerostin levels are elevated in patients with chronic kidney disease and end-stage renal disease. Since data for patients after kidney transplantation are sca...

mTOR inhibitors avoid calcineurin nephrotoxicity, but sirolimus de novo is associated with unacceptable side effects and higher rejection rates. We have investigated a modified strategy: alemtuzumab induction with tacrolimus and mycophenolate maintenance, switching from tacrolimus to sirolimus at 6 months and stopping mycophenolate at 12 months. He...

Background: This study evaluated the effect of liver transplantation (LTX) and STACE on overall survival in palliative patients with HCC exceeding Milan criteria. Material and methods: At a single center 63 HCC patients exceeding Milan criteria were retrospectively analyzed. Forty patients underwent STACE as palliative therapy modality and 23 pa...

Purpose: Poor arterial inflow during orthotopic liver transplantation (OLT) may necessitate arterial revascularisation using aorto-hepatic bypasses with supraceliac (SC) or infrarenal (IR) allografts. This study compared both techniques focusing on the patients' preoperative conditions, postoperative graft/organ function, complications and surviva...

Combined pancreas and kidney transplantation is the therapy of choice for type I diabetes patients with associated end-stage renal disease. To counterbalance increasing waiting lists, there is a clear need to extend the organ donor pool. Although results following simultaneous pancreas and kidney transplantation (SPK) using pediatric organs are enc...

Early conversion to a calcineurin-inhibitor (CNI)-free maintenance immunosuppression with sirolimus (SRL), mycophenolate mofetil (MMF) and steroids was associated with an improved 1-year renal function as compared with a cyclosporine (CsA)-based regimen (SMART core-study). This observational follow-up describes 132 patients followed up within the S...

Chatzizacharias NA, Vaidya A, Sinha S, Sharples E, Smith R, Jones G, Brockmann J, Friend PJ. Risk analysis for deterioration of renal function after pancreas alone transplant. Clin Transplant 2011 DOI: 10.1111/j.1399-0012.2011.01534.x. © 2011 John Wiley & Sons A/S. Abstract: The risk of progression to renal replacement after pancreas transplant alo...

The donor transplant coordinator arranges the transport of the surgical team to and from the donor hospital. Withinthe EU region, it is advisable to bring personal ID (e.g. passport). Separate arrangement of transport for the thoracicprocurement team is necessary because of reduced cardiac and pulmonary ischemic tolerance.After arrival in the donor...

The increasing demand for transplantation has led to consideration of liver grafts from donors exposed to hepatitis B virus (HBV). Six transplantations of liver grafts from hepatitis B surface antigen (HBsAg) positive donors have been reported; two recipients suffered from HBV/HDV (hepatitis Delta virus) coinfection and were followed up for 10-12 m...

Chapter 9 discussesI imunosuppression for pancreas transplantation, including side effects and cardiovascular complications of immunosuppressive drugs, graft thrombosis, and immunological monitoring of the transplanted pancreas.

This resource reflects recent advances in the field of pancreas transplantation, especially the increasing number of islet transplantations and the growing interest in stem cell research applicable to this condition. It provides an authoritative account on the current status of the whole organ pancreas transplantation and islet and pancreatic stem...

Rejection of a liver transplant is a rare but serious event which can be life threatening. T-cells were supposed to be the major, if not the only key player in allograft rejection. However, during recent years B-cell function has regained attention. A chimeric monoclonal antibody against CD20 protein (rituximab) successfully reversed a multi-drug r...

De novo sirolimus in calcineurin inhibitor-free regimens, although potentially useful to improve early renal function, are complicated by various drug-related side effects. We report a prospective open-label, multicenter, randomized trial to evaluate early conversion from a CsA-based to a sirolimus (SRL)-based regimen 10 to 24 days after renal tran...

Abstract PURPOSE OF REVIEW: There is increasing disparity between the supply of acceptable donor organs and the number of potential transplant recipients. The shortage of organs for transplantation demands optimal utilization of a wider spectrum of donor organs, including nonheart-beating and other extended criteria donors. In the case of the liver...

There is increasing disparity between the supply of acceptable donor organs and the number of potential transplant recipients. The shortage of organs for transplantation demands optimal utilization of a wider spectrum of donor organs, including nonheart-beating and other extended criteria donors. In the case of the liver, a substantial number of or...

A 28-year-old man suffering from a Ewing tumour arising from the 9th-11th ribs with infiltration of neuroforamina without distant metastases was planned to receive radiotherapy following primary intralesional surgery and induction chemotherapy. Due to pleural infiltration and effusion, a hemithorax irradiation with a sequential boost to the primary...

Introduction: Increasing pancreas transplant activity in the last few years has exposed the shortage of 'standard donors' for transplantation. In an effort to increase the potential donor pool, we liberalized our criteria for acceptance of pancreases. The graft and patient outcomes from such pancreas transplants are compared with the standard cohor...

Transplantation of organs retrieved after cardiac arrest could increase the donor organ supply. However, the combination of warm ischemia and cold preservation is highly detrimental to the reperfused organ. Our objective was to maintain physiological temperature and organ function during preservation and thereby alleviate this injury and allow succ...

The quality of organ preservation is critical to the outcome of transplantation: preservation technology is a limiting factor in the further development in the use of marginal donor organs. Normothermic preservation (preservation at normal physiological temperature) enables prolonged preservation, resuscitation after warm ischemia and organ viabili...

Purpose: To study the impact of Campath induction in pancreas transplantation, with particular reference to steroid avoidance. Methods: Campath (alemtuzumab) is a humanised anti-CD52 T & B-cell depleting antibody, clinically effective in many immune-mediated disorders. From August 2004 to November 2008, 234 pancreas transplants were performed in 23...

The present study reports a German survey addressing outcomes in nonselected historical series of liver transplantation (OLT) for hilar cholangiocarcinoma (HL). We sent to all 25 German transplant centers performing OLT a survey that addressed (1) the number of OLTs for HL and the period during which they were performed; (2) the incidence of HL dia...

The use of vascular staplers in liver resection is well established.1 An umbilical tape or sling is usually recommended to loop the portal or hepatic venous structures prior to stapling. However, these need to be removed before firing, or may be included in the fired stapler, and could cause the stapler to misfire. This results in lack of traction...

Revascularization of the gastro-epiploic artery in pancreas transplant doi:10.1111/j.1432-2277.2008.00757.x We read with interest the article on revascularization of the gastro-epiploic artery in pancreas transplants [1], in which the author describes personal experience in 110 consecutive pancreas transplants. We agree that the revascularization...

The Carney complex is a multiple neoplasia syndrome characterized by myxomas, schwannomas, mucocutaneous spotty pigmentations, and endocrine overactivity with or without endocrine tumors. Herein, we report the rare case of a 49-year-old man with a paravertebral intrathoracic tumor, a history of bilateral adrenalectomy, and resection of an atrial my...

ZusammenfassungDie Leberchirurgie hat in den letzten Jahren zunehmend an Bedeutung gewonnen. Durch Verbesserungen des prä-, intra- und postoperativen Managements werden zunehmend aggressivere chirurgische Therapieverfahren durchgeführt. Auch makroskopische Veränderungen der Leber, sowie Komorbiditäten seitens des Patienten stellen heute keine absol...

Delayed graft function after deceased-donor transplant remains a significant clinical problem. The conventional definition of delayed graft function is the requirement of dialysis within the first week after transplant, but this criterion has many problems that have led to many controversies including those of incidence and significance. Therefore,...

Simultaneous pancreas-kidney transplantation is the treatment of choice for patients suffering from type 1 diabetes mellitus and end-stage renal failure secondary to diabetic nephropathy. Until 1995, about 90% of pancreas transplantations were performed with exocrine drainage into the bladder. Since then the proportion of pancreas transplants with...

The treatment of patients with central liver tumors involving segments 4, 5 and 8 is a difficult clinical problem. These tumors often straddle Cantlie's line and involve parts of both lobes of the liver. The traditional management of such tumors is to perform either an extended right or an extended left hepatectomy. However, extended hepatectomies...

Living donor nephrectomy (LDN) has evolved a variety of different surgical techniques. Minimal invasive strategies were introduced to benefit the healthy donors. This paper attempts to identify the best possible practise in live kidney donation with special respect to donor safety. We present a single-centre experience of 173 live kidney donations...

According to the German transplantation law of 1997 the ethical and psychopathological investigation of potential donors before a living donation is a major basis of the decision of the expert commission at the General Medical Council. But the concrete practice in the different transplantation regions is somehow varying with respect to micro goals,...

Light microscopic alterations reflecting both previous and preservation-induced changes in the donor organ are usually not very distinctive. The ischemia/reperfusion-associated injury depends primarily on the conditions of donor organ preservation. The present study examined human kidney biopsies with special attention paid to the molecular mechani...

The organ shortage has led to increasing acceptance of living donation in all transplant centers. Although the risk of impaired long-term outcome seems to be greater using elderly donors, these organs are not generally refused for transplantation. We report our experience with 25 living donor kidney transplantations from donors older than 60 years....