C Zapletal

University Hospital Frankfurt, Frankfurt, Hesse, Germany

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Publications (36)39.23 Total impact

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    ABSTRACT: Patients with hemophilia were at high risk of acquiring blood-borne infections transmitted by factor VIII or factor IX concentrates which were not virus inactivated before 1986.
    No preview · Chapter · Dec 2007

  • No preview · Chapter · Dec 2006
  • C. W. Strey · C. Zapletal · W. O. Bechstein
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    ABSTRACT: Die chirurgische Therapie des hepatozellulren Karzinoms (HCC) mit vollstndiger Entfernung des Tumors oder die Lebertransplantation kann eine langfristige Heilung ermglichen. Beide Verfahren sind primr oder im Rahmen neoadjuvanter Konzepte durchfhrbar. In bestimmten Fllen kann ein lokoregionres Verfahren mit kurativer Zielsetzung angewandt werden. Die Zuordnung des Patienten zu einer primr chirurgisch kurativen, neoadjuvanten oder palliativen Vorgehensweise ist, neben der hepatischen und extrahepatischen Tumorausdehnung, von der vorbestehenden chronischen Leberschdigung abhngig. Die individuelle Grenze der Resektabilitt ergibt sich aus der notwendigen Radikalitt und dem fr eine suffiziente postoperative Leberfunktion erforderlichen Parenchymrest. Aus diesem Grund ist das Ausma der zirrhotischen Leberschdigung fr die Auswahl und die Sequenz der Therapiemanahmen entscheidend.Surgical treatment with complete resection of the hepatocellular carcinoma and liver transplantation can lead to a long term cure. If needed both surgical approaches can be incorporated into a neoadjuvant concept. In certain cases locoregional tumor treatment with curative intent can establish tumor control. Patients with established diagnosis are assigned to the corresponding surgical curative, neoadjuvant or palliative therapeutic approach according to the tumor stage and degree of parenchymal liver damage. The individual resection requirements to achieve tumor control and the acceptable limit of remnant liver volume to maintain liver function, define the individual feasibility of liver resection. For this reason sequence and choice of the therapeutic measures are determined by the extent of chronic functional impairment of the liver.
    No preview · Article · Dec 2006 · Der Gastroenterologe
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    ABSTRACT: The main cause of death for diabetic patients and patients on dialysis is coronary artery disease (CAD). The most common cause of graft loss following simultaneous pancreas and kidney transplantation (SPK) is death with a functioning graft due to CAD. Therefore, careful pretransplantation evaluation of CAD is mandatory. In our series, every patient undergoes a noninvasive cardiac function test like dobutamine stress echocardiography (DSE) or myocardial thallium scintigraphy using adenosine to induce medical stress. Thirty patients were evaluated for SPK: 15 patients with myocardial scintigraphy and 8 with DSE. Seven investigations showed pathological findings and we performed coronary angiograms, none of which showed coronary artery stenosis. Seven primary coronary angiograms were performed: four due to a history of CAD and three as a primary diagnostic. Following SPK one patient died at 21 days after transplantation due to myocardial infarction. He had a history of CAD with angioplasty and stent implantation. Noninvasive cardiac function tests like DSE or myocardial scintigraphy are reliable methods to evaluate CAD in patients with diabetic nephropathy awaiting SPK. In case of a suspicious finding or a history of CAD, a coronary angiogram should be performed to assess the need for revascularization. Following this algorithm we may further reduce the mortality of SPK.
    No preview · Article · May 2006 · Transplantation Proceedings
  • M Golling · C Gog · G Woeste · C Zapletal · C Wullstein · W O Bechstein
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    ABSTRACT: Liver resection for colorectal metastases disease can be performed with curative intent at low morbidity and mortality. Only 15-30 % of liver metastases are amenable to potentially curative resection. Five year survival following primary and repeat liver resection has consistently been reported as 25-40 %. Future strategies focus at widening the indication and extending therapeutic options. The aim of neoadjuvant treatment of irresectable liver metastasis is the conversion to secondary resectability either via increasing residual liver mass (portal vein embolisation/2-stage resection) and/or reducing tumor load via chemotherapy ("down-sizing"). Current data suggest resectability following neoadjuvant chemotherapy in around 8 % of cases but varying between 1-33 %.
    No preview · Article · May 2006 · Zentralblatt für Chirurgie
  • M. Golling · C. Gog · G. Woeste · C. Zapletal · C. Wullstein · W. Bechstein

    No preview · Article · Apr 2006 · Zentralblatt für Chirurgie
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    ABSTRACT: Laparoscopic pancreatic resection is rarely described. Telerobotic-assisted laparoscopy may offer some advantages for resection of the pancreatic tail. A 49-year-old woman was diagnosed with insulinoma located in the pancreatic tail. Telerobotic-assisted laparoscopic spleen-preserving resection of the pancreatic tail was performed. Operation time was 195 minutes. The postoperative course was uneventful. The previously described advantages of a telerobotic approach with extended range of motion and three-dimensional view make more complex operations like pancreatic resection possible and may offer extended indications for laparoscopic surgery.
    Full-text · Article · Feb 2006 · HPB
  • G Woeste · C Zapletal · C Wullstein · M Golling · W.O. Bechstein
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    ABSTRACT: The prevalence of methicillin-resistant Staphylococus aureus (MRSA) has increased worldwide and MRSA has emerged as an important cause of sepsis in cirrhotic patients and liver transplant recipients. In this retrospective study, the prevalence of MRSA colonization and its influence on infections following orthotopic liver transplantation (OLT) was investigated. From August, 2002 until November, 2004, 66 primary cadaver OLT were performed for adult recipients. Antibody induction used Daclizumab (n = 49) or ATG (n = 14). Maintenance immunosuppression consisted of tacrolimus and steroids, with 30 patients receiving mycophenolate mofetil and 4, rapamune. For perioperative anti-infectious prophylaxis cefotaxime, metronidazole, and tobramycin were administered for 48 hours. The preoperatively performed routine swabs revealed MRSA colonization in 12 of 66 (18.2%) patients. The stage of cirrhosis was equivalent for MRSA(-) patients according to Child score. The mean MELD score was significantly higher for MRSA(+) patients (24.3 versus 18.7, P = .036). More MRSA(+) patients were hospitalized at the time of transplantation (14/54 versus 8/12, P = .018). The incidence of posttransplant infections was not significantly different among the two groups. Within the first year 7 of 66 (10.6%) patients died: 3 of 12 (25%) MRSA(+) and 4 of 54 (7.4%) MRSA(-). The 1-year survival was lower in the MRSA(+) group (74.1% versus 94.1%). In conclusion, this study did not show that an MRSA-positive carrier status implies an increased risk for septic complications following OLT. Mortality was increased for MRSA(+), but failed to show a significant difference. A significantly higher MELD score and pretransplant hospitalization for MRSA(+) patients may contribute to the higher mortality and reflect sicker patients.
    No preview · Article · Jun 2005 · Transplantation Proceedings
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    ABSTRACT: Facing an increasing shortage of donor organs, donor criteria become more extended and so-called marginal organs are accepted for transplantation. For liver donation donor age above 70 years is accepted as a risk factor concerning primary dysfunction or nonfunction. Therefore, the aim of this study was to compare the early outcome of grafts older versus younger than 80 years of age. Between August 2002 and February 2004, 40 adult liver transplants were performed using triple immunosuppression with tacrolimus, MMF, and low-dose corticosteroids. Recipients with HCC received low-dose rapamycin after postoperative day 14. The outcome of grafts from donors under 80 years of age (n=35) was compared with those from donors 80 years old or more (n=5). For statistical analysis Mann-Whitney-U-Test and Fisher's Exact Test were used with P < .05 considered statistically significant. The average donor age of our population was 54.4 +/- 17.3 years with five donors older than 80 years (80-83 years). These donors all had additional risk factors. The recipients of the latter grafts suffered from HCC and liver cirrhosis Child A (n=2) or from viral hepatitis (n=3). One recipient had advanced cirrhosis with severe complications. The outcomes of both groups were comparable concerning intraoperative and postoperative courses. All recipients of old liver grafts left the hospital with stable graft function. Liver grafts over 80 years can be transplanted with good results, especially if given to recipients with malignancy and otherwise stable liver function.
    No preview · Article · Apr 2005 · Transplantation Proceedings
  • C Wullstein · G Woeste · C Zapletal · WO Bechstein

    No preview · Article · Jan 2005 · Zeitschrift für Gastroenterologie
  • Ch. Zapletal · M. Golling · W.O. Bechstein
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    ABSTRACT: Ischemia/reperfusion injury takes up a central role in organ transplantation. In a multifactorial process, I/R is responsible for early as well as late graft function. In this setting donor-derived independent (age, sex, hypertension, diabetes, brain death) as well as dependent (cardiocirculatory instability, catecholamines) factors are often underestimated compared to other risk factors like procurement, preservation and finally reperfusion. This article gives an overview on the donor-derived risk factors in view of an improved assessment of so called "marginal" or "compromised" donor organs. While the influence of donor factors on graft function has been shown in retrospective multivariate analyses of transplant registries, recent improvements in results despite the use of compromised donors disprove the hypothesis. In recent years, although unavoidable, brain death and intensive care have become the focus of attention in research assessing donor organs and can be held partially responsible for the improved results in living related organs. Maintenance of adequate perfusion pressure as well as a sufficient fluid- and electrolyte balance is obvious and does not require further explanation. Whether avoidance of parenteral nutrition or supplementation with enteric immunonutrition (e.g. small bowel donor) respectively hormones will reduce I/R damage remains to be seen. Most research is currently aimed at preconditioning of the transplant with potentially protective substances (antioxidants etc.) or temporary ischemia. Final results are pending. Only after protective measurements have been taken, predictive markers of posttransplant organ function have been assessed and legislation has approved "non heart beating donors" can be recruited to supplement the donor organ pool.
    No preview · Article · Jan 2005 · TransplantLinc
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    ABSTRACT: The outcome after live-donor kidney transplantation is influenced by many parameters. The aim of our study was to establish a multivariate prognostic model for calculating the recipient's creatinine clearance after transplantation. Basic immunological, donor-, recipient- and process-related variables were assessed in a series of 18 live-donor kidney transplant patients with an uncomplicated postoperative course. Multivariate analysis was carried out with automated forward and backward selection. The following four parameters were included in the predictive model: recipient age, recipient BMI, graft clearance and degree of relationship. The coefficient of determination (R(2)) was 0.67. It could be shown that a significant prediction of creatinine clearance after living related kidney transplantation can be made, based on simple variables. Therefore, this formula could help to detect early complications in the post-transplantation course if the recipient's creatinine clearance drops below the predicted result.
    Full-text · Article · Nov 2004 · Transplant International

  • No preview · Article · Jul 2004 · Transplantation
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    Ch Zapletal · L Herzog · G Martin · E Klar · P J Meeder · J Buchholz
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    ABSTRACT: The quantification of tissue perfusion in different parenchymal organs like liver, kidney, and brain by means of thermodiffusion has recently been validated experimentally and was introduced into clinical practice. Traumatology and plastic surgery deal as well with issues of microcirculation. Therefore, it was the aim of this study to validate thermodiffusion for use in skeletal muscle. Eighteen patients were studied during knee arthroscopic procedures that utilized a tourniquet. A thermodiffusion probe was inserted in the tibialis anterior muscle of the side under treatment. Measurement started before the initiation of limb ischemia (by tourniquet) and continued throughout the procedure until tissue perfusion returned to normal values postoperatively. Furthermore, an example of clinical applicability of this technique is given by monitoring muscle tissue perfusion in 3 patients with imminent compartment syndrome. Preoperative values of muscle tissue perfusion in the patients undergoing arthroscopic procedures were 17.74 +/- 4.27 ml/min 100 g. After initiation of tourniquet perfusion quickly decreased to 3.59 +/- 3.53 ml/min 100 g. Upon reperfusion tissue perfusion increased to values above normal for a few minutes and then returned to preischemic values of 20.86 +/- 7.01 ml/min 100 g. There was no significant difference between pre- and postoperative values (P=0.154) but tissue perfusion during tourniquet was significantly reduced (P=0.0001). In 3 patients presenting with the clinical signs of imminent compartment syndrome, thermodiffusion measurement was applied and showed microcirculatory impairment of different degrees. Fasciotomy was followed by a prompt increase of muscle microcirculation to levels slightly above normal. In summary, valid and stable measurements of tissue perfusion in skeletal muscle by means of thermodiffusion are possible under clinical circumstances. Thermodiffusion allows for on-line monitoring of muscle microcirculation, e.g., in compartment syndrome. The clinical potential of thermodiffusion measurements in trauma surgery needs further prospective evaluation.
    Full-text · Article · Oct 2003 · Microvascular Research
  • G. Woeste · C. Wullstein · C. Zapletal · W.O. Bechstein
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    ABSTRACT: Simultaneous pancreas-/kidney transplantation (SPK) is a life-saving procedure for type 1 diabetics with renal insufficiency. There is a higher incidence of relaparotomies compared to other whole organ transplantations. From 9/2000 - 5/2002 55 SPK were performed at the transplant center of the Ruhr University, Bochum. In total, 21.8% of the patients underwent a relaparotomy, the most frequent indications were pancreas graft thrombosis (7.3%) and graft pancreatitis (5.5%). All pancreas grafts from patients with thrombosis had to be removed, graft function in patients with pancreatitis could be preserved after relaparotomy. 23.6% of the patients had an episode of rejection. Due to rejection, 1 pancreas and 3 kidneys were lost. Of the 55 patients, 3 (5.5%) died, 1 patient (1.8%) died due to hemorrhage 14 days after transplantation, 1 due to sepsis 176 days after transplantation and 1 due to pulmonary embolism 570 days after transplantation. Postoperative complications following SPK can mostly be treated successfully without jeopardizing the patients' lives or graft function. Due to the life-saving effect and the improved survival rates, SPK can be considered a routine procedure for type 1 diabetics with end-stage renal disease.
    No preview · Article · Jul 2003 · Nieren- und Hochdruckkrankheiten

  • No preview · Article · Jun 2003 · Transplantation Proceedings
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    ABSTRACT: In clinical practice, a heterogeneous hepatic tissue microperfusion (MC) is often observed after liver resection or transplantation (LTx). Nevertheless this hepatic perfusion phenomenon has never been really quantified with respect to its anatomic distribution and time course in detail. The aim of the study was to characterize liver perfusion heterogeneity and local flow kinetics both in the physiological situation and after standardized ischemia and reperfusion using an established model of porcine LTx. Regional distribution of hepatic MC in healthy native porcine livers (control group; n = 8) was analyzed in comparison with data derived 60 min, 24 h, and 72 h after porcine LTx (transplantation group; n = 8 each subgroup; cold ischemia time: 5.7 +/- 1.2 h). MC was measured with implanted thermal diffusion electrodes (TD). Flow in hepatic artery and portal vein was continuously detected by ultrasonic probes. For standardization of measurement localizations, porcine liver lobes were divided anatomically into three horizontal layers (cranial, medial, caudal), defining 12 distinct hepatic measurement regions. In the control group, a homogenous liver MC with a mean flow of 81.6 +/- 13.9 ml/100 g/min was detected in all regions. After LTx, a marked MC heterogeneity was noted 60 min after reperfusion. MC rehomogenization was first documented within horizontal liver planes 24 h later. Comparison of MC between planes showed persisting heterogeneity with a significant intralober drop of mean MC in the cranio-caudal direction. Complete MC rehomogenization (both between horizontal and vertical liver planes) was detected 72 h after reperfusion. Still, an overall reduction of mean liver perfusion by about 15% was existent. A homogenous tissue perfusion was observed in healthy porcine livers. In contrast, marked heterogeneity of hepatic MC was detected after LTx. Heterogeneity presents as a very dynamic and temporary phenomenon. Early horizontal flow rehomogenization and reconstitution of normal blood flow, particularly primarily in the cranial liver layers, appear to be characteristic features during early flow reconstitution after postischemic reperfusion. Due to heterogeneity and time-dependent flow dynamics, measurement of MC volumes at single hepatic regions may not always allow a valid characterization of liver perfusion quality during the first 24 h after postischemic reperfusion.
    No preview · Article · Apr 2003 · Microvascular Research
  • C Wullstein · G Woeste · C Zapletal · K Dette · W O Bechstein
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    ABSTRACT: Graft thrombosis is one of the main reasons of graft loss following simultaneous pancreas-kidney transplantation (SPK). Although antiphospholipid syndrome (APLS) is known as a high risk for graft thrombosis in kidney transplants alone, little is known about APLS in SPK. Between September 2000 and December 2001, 45 SPK were performed. The treatment and clinical course of 2 patients with APLS is presented. In one patient, APLS was known before transplantation. After SPK, she was treated by systemic heparin followed by coumarin. Both grafts are doing well 5 months posttransplant. The second patient underwent SPK without knowledge of APLS. The patient developed a deep vein thrombosis 5 weeks posttransplant. Hypercoagulability screening revealed APLS. Treatment consisted of systemic anticoagulation. Grafts were not affected. SPK can successfully be performed in APLS patients if anticoagulation is performed consistently. To reduce the risk of graft thrombosis, a pretransplant screening for APLS would probably be of benefit.
    No preview · Article · Mar 2003 · Transplantation
  • G. Woeste · C. Wullstein · C. Zapletal · W.O. Bechstein

    No preview · Article · Jan 2003 · Nieren- und Hochdruckkrankheiten
  • C Welp · S Siebers · C Zapletal · H Ermert · W O Bechstein · J Werner
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    ABSTRACT: In recent years thermal ablation of liver tumors as a minimally invasive method became a promising alternative to conventional strategies such as chemotherapy or resection of liver tissue. Thereby an electrode is placed inside the tumor delivering energy in the form of high frequency current into the target volume to achieve and maintain a tissue temperature between 60 and 100 degrees C. Cells exposed to this thermic stress undergo coagulation necrosis and are irreversibly damaged. To protect vital liver structures from heat, it is necessary to develop an online temperature monitoring system. An experimental setup perfusing isolated pig livers under physiological conditions with 0.9% NaCl solution was established to develop and evaluate the measuring technique.
    No preview · Article · Feb 2002 · Biomedizinische Technik

Publication Stats

200 Citations
39.23 Total Impact Points


  • 2006
    • University Hospital Frankfurt
      Frankfurt, Hesse, Germany
  • 2005
    • Goethe-Universität Frankfurt am Main
      Frankfurt, Hesse, Germany
  • 2003-2004
    • Ruhr-Universität Bochum
      • Chirurgische Klinik und Poliklinik
      Bochum, North Rhine-Westphalia, Germany
  • 1999-2003
    • Heidelberg University
      • Department of Spine Surgery
      Heidelburg, Baden-Württemberg, Germany