Signs of reperfusion injury following CO2 pneumoperitoneum: an in vivo microscopy study.

Background: During laparoscopic surgery, pneumoperitoneum is generally established by means of carbon dioxide (CO(2)) insufflation which may disturb hepatic microperfusion. It has been suggested that the desufflation at the end of the procedure creates a model of reperfusion in a previously ischemic liver, thus predisposing it to reperfusion injury.

Methods: To study the effects of pneumoperitoneum on hepatic microcirculation, Sprague-Dawley rats underwent pneumoperitoneum with an intraabdominal pressure of 8 or 12 mmHg for 90 min.

Distinct effects of surgical denervation on hepatic perfusion, bowel ischemia, and oxidative stress in brain dead and living donor porcine models.

The liver function and perfusion following brain death is mainly influenced by the sympathetic nerves and hormones. We examined the specific influence of surgical liver denervation on systemic and hepatic perfusion parameters, bowel ischemia and oxidative stress in hemodynamically stable BD and control (living donor [LD]) pigs. Brain death was induced in 8 pigs via saline infusion into the balloon of an epidural Tieman-catheter (1 mL/15 minutes) and compared to the control group (n = 6) over 4 hours.

Hepaticojejunostomy--analysis of risk factors for postoperative bile leaks and surgical complications.

Anastomoses between the jejunum and the bile duct are an important component of many surgical procedures; however, risk factors for clinically relevant bile leaks have not yet been adequately defined. The objective of this study was to describe the incidence of bile leaks after hepaticojejunostomy and to define predictive factors associated with this risk and with surgical morbidity. Between October 2001 and April 2004, hepaticojejunostomies were performed in 519 patients in a standardized way.

Review of the clinical experience with a modified release form of tacrolimus [FK506E (MR4)] in transplantation.

Non-compliance in solid transplantation recipients is a major factor in acute graft rejection, which influences patient survival. Nowadays, tacrolimus is one of the most widely used immunosuppressant agents together with cyclosporine following kidney and liver transplantation with a standardized twice-daily dosing regimen. To improve the patients' compliance to the prescribed immunosuppressive therapy, FK506E (MR4), a modified release (MR) oral dosage form of tacrolimus has been developed for a once-daily dosing regimen.

Controlled-surgical education in clinical liver transplantation is not associated with increased patient risks.

Introduction: A qualified surgical team is required to perform liver transplantation (LTX). Growing numbers of transplants at transplant centers and large variations of transplant frequencies make a continuous education to train young surgeons on this complex field of hepato-biliary surgery mandatory, both from the organizational and motivational point of view (job enrichment and professional growth). On the contrary, perioperative patient risk management is of major importance in surgical practice and given growing organizational concern in hospitals.

Living-donor kidney transplantation: risks of the donor--benefits of the recipient.

For patients with end-stage renal disease, kidney transplantation is the optimal therapy. Due to organ shortage, however, most patients have to wait on dialysis for a considerable period of time prior to transplantation. Living-donor kidney transplantation is a valid option to expand the organ pool and to reduce waiting time.

Primary malignant hepatic epithelioid hemangioendothelioma: a comprehensive review of the literature with emphasis on the surgical therapy.

Malignant hepatic epithelioid hemangioendothelioma (HEH) is a rare malignant tumor of vascular origin with unknown etiology and a variable natural course. The authors present a comprehensive review of the literature on HEH with a focus on clinical outcome after different therapeutic strategies. All published series on patients with HEH (n = 434 patients) were analyzed from the first description in 1984 to the current literature.

Differentially expressed genes in postperfusion biopsies predict early graft dysfunction after liver transplantation.

Background: Preservation induced injury is a major contributing factor to early graft dysfunction in liver allograft recipients. We hypothesized that changes in gene expression represent the earliest indicator of ischemia/reperfusion-related injuries measurable in the graft and could be used as prognostic marker for the occurrence of graft-related complications.

Methods: We studied the expression of 67 genes, known to play a role in acute inflammatory processes by real-time polymerase chain reaction in 59 postperfusion biopsies.

The vital threat of an upper gastrointestinal bleeding: Risk factor analysis of 121 consecutive patients.

Aim: To analyze the importance in predicting patients risk of mortality due to upper gastrointestinal (UGI) bleeding under today's therapeutic regimen.

Methods: From 1998 to 2001, 121 patients with the diagnosis of UGI bleeding were treated in our hospital. Based on the patients' data, a retrospective multivariate data analysis with initially more than 270 single factors was performed.

A routine liver transplantation in a patient with situs inversus: a case report and an overview of the literature.

Liver transplantation (LT) in an adult with situs inversus (SI) is extremely rare and requires precise pre-operative management. A 48-yr-old male with SI suffering from alcoholic liver cirrhosis underwent LT at our institution in March 2003. Pre-operatively, liver anatomy was determined by CT scan, three-dimensional liver reconstruction and angiography.

TIPSS for variceal hemorrhage after living related liver transplantation: a dangerous indication.

The introduction of transjugular intrahepatic portal-systemic stent-shunt (TIPSS) has been a major breakthrough in the treatment of portal hypertension, which has evolved to a large extent, into a routine procedure. A 21-year-old male patient with progressive graft fibrosis/cirrhosis requiring TIPSS for variceal hemorrhage in the esophagus due to portal hypertension was unresponsive to conventional measures two years after living related liver transplantation (LDLT). Subsequently, variceal hemorrhage was controlled, however, liver function decreased dramatically with consecutive multi organ failure.

Stapler hepatectomy is a safe dissection technique: analysis of 300 patients.

Background: In many surgical procedures, stapling devices have been introduced for safety and to reduce the overall operative time. Their use for transection of hepatic parenchyma is not well established. Thus, the feasibility of stapler hepatectomy and a risk analysis of surgical morbidity based on intraoperative data have been prospectively assessed on a routine clinical basis.

Cost distribution of orthotopic liver transplantation: single-center analysis under DRG-based reimbursement.

Costs of orthotopic liver transplantation (OLT) are influenced by multiple factors. Surgeons must be interested in determining the probability of meeting the projected cost averages. Costs of procedures, labor, drugs and pharmaceuticals, materials, and overhead costs of infrastructure were calculated during the primary stay in 38 consecutive patients undergoing OLT at a single center.

Indications for liver transplantation in patients with amyloidosis: a single-center experience with 11 cases.

Familial amyloidotic polyneuropathy (FAP) is an inherited disorder with the systemic deposition of amyloid fibrils containing mutant transthyretin variants. The mutant form of transthyretin amyloidosis is produced mainly in the liver. Successful liver transplantation (LTx) could eliminate the source of the variant transthyretin molecule, and is now the only known curative treatment.

Evolution of liver transplantation at the University of Heidelberg: interventions influencing patient referral.

In Heidelberg, liver transplantation was first performed in 1987. In this article, we report our experience with an interdisciplinary approach (intervention) to improve the internal and external acceptance of the liver transplantation program. Formation of a transplant team and interdisciplinary standard setting of pre-, peri-, and postoperative protocols significantly stimulated this process.

Living related liver transplantation: the ultimate technique to expand the donor pool?

Today, living donor liver transplantation (LDLT) is well established in many centers as a therapeutic method for end-stage liver disease. LDLT is an option for selected cases and is still under development. From the beginning of LDLT until now, many innovations have been presented and as a consequence both the surgical and medical complications in both donors and recipients reduced greatly.

Surgical treatment of primary hepatic epithelioid hemangioendothelioma.

Epithelioid hemangioendothelioma is a very rare tumor of vascular origin. It can develop in different tissues such as soft tissue, lung, or liver. Hepatic epithelioid hemangioendothelioma (HEH) mostly affects females.

Liver transplantation for hepatocellular carcinoma: is there evidence for expanding the selection criteria?

A consequent application of the Milan criteria in patients undergoing liver transplantation for hepatocellular carcinoma (HCC) may lead to excellent long-term survival and a low incidence of recurrence. Expanding the selection criteria will result in more patients with hepatocellular carcinoma being potentially curative treated, but this approach is associated with at least a higher incidence of recurrence. Kaplan-Meier analysis of 110 patients, who underwent liver transplantation for HCC in our institution between 1987 and 2004, showed a significant improvement in patient survival with time.

HEGPOL: randomized, placebo controlled, multicenter, double-blind clinical trial to investigate hepatoprotective effects of glycine in the postoperative phase of liver transplantation [ISRCTN69350312].

Background: Kupffer cell-dependent ischemia/reperfusion (I/R) injury after liver transplantation is still of high clinical relevance, as it is strongly associated with primary dysfunction and primary nonfunction of the graft. Glycine, a non-toxic, non-essential amino acid has been conclusively shown in various experiments to prevent both activation of Kupffer cells and reperfusion injury. Based on both experimental and preliminary clinical data this study protocol was designed to further evaluate the early effect of glycine after liver transplantation.

Taurine improves graft survival after experimental liver transplantation.

Relevant mechanisms of reperfusion injury after liver transplantation are most likely mediated by activated Kupffer cells. Recently, it has been demonstrated that taurine prevents Kupffer cell-activation in vitro. Thus, this study was designed to assess the effects of taurine after liver transplantation.

Negative impact of systemic catecholamine administration on hepatic blood perfusion after porcine liver transplantation.

Catecholamines are often administered during and after liver transplantation (LTx) to support systemic perfusion and to increase organ oxygen supply. Some vasoactive agents can compromise visceral organ perfusion. We followed the hypothesis that the vasculature of transplanted livers presents with a higher sensitivity, which leads to an increased vulnerability for flow derangement after application of epinephrine (Epi) or norepinephrine (NorEpi).

Different impact of normo- and hypotensive brain death on renal macro- and microperfusion--an experimental evaluation in a porcine model.

Background: Despite the growing use of kidneys from living donors, organs harvested from brain dead donors are the dominant graft types used in renal transplantation. It is accepted that brain death (BD) has a damaging effect on the renal allograft, with a lower graft survival. Amongst various causes, changes in renal microperfusion could be responsible.

Long-term results of paediatric kidney transplantation at the University of Heidelberg: a 35 year single-centre experience.

Background: Kidney transplantation remains the most effective treatment for children with end-stage renal disease. We analysed data from the University of Heidelberg transplant programme to present our results on paediatric kidney transplantations over the past 35 years.

Methods: From 1967 to 2003, 354 paediatric kidney transplantations were performed at the University of Heidelberg.