Liver transplantation

Human liver transplantation, which was first performed in man in Denver 15 years ago, has finally come of age in the past 2 years. The 1 year survival has improved from 28 per cent to 50 per cent in the recent Denver Second Series. Past experience has shown that long-term prognosis can usually be determined based on the 1 year assessment. Patients who are fit with a well functioning liver are likely to remain well. This applied to the 45 per cent of the 1 year survivors in the First Denver Series, who are still alive today at between 2 5/6 and 8 5/6 years. It has however, been a much more frequent finding in the Second Series, which suggests that a significant number of patients should be long-term survivors in the future. Improved survival has been attributed to a number of factors including a better understanding of the rejection and infection problems in immunosuppressed liver recipients. Postoperative hepatic dysfunction is no longer as easily ascribed to rejection, and an aggressive diagnostic approach has helped to prevent over-immunosuppression. Furthermore, new approaches to the biliary anastomosis, and a better understanding of the blood supply of the human bile duct, is currently preventing many of the earlier catastrophes related to this, the Achilles heel of liver tranplantation

Gastrointestinal complications of hepatic transplantation

In this series of 150 orthotopic hepatic transplants, clinically significant gastrointestinal hemorrhage occurred in 34 patients (23%). Five patients (15%) survived this complication. Enteric perforations occurred in 20 patients following 198 biliary-enteric procedures. Only one patient survived. Enteric perforations unrelated to biliary procedures fared only slightly better with one survivor among eight perforations. These results clearly do not warrant complacency. Modifications advocated are an aggressive diagnostic approach and early reoperation with establishment of extensive peritoneal drainage where necessary

Liver Resection for Hepatic Adenoma

Between 1970 and 1978, eight hepatic adenomas were resected. Four of the eight patients took oral contraceptive pills before the hepatic adenoma was identified; one patient was male. Four patients had evidence of bleeding at the time of presentation. The original histologic diagnosis in the first five patients was malignant hepatoma. There has been no known recurrence of tumor and all patients are well. The use of oral contraceptives in these patients has been prohibited. Formal anatomic resection is recommended for hepatic adenoma when this procedure can be done without mortality or serious morbidity; however, in the future, less drastic treatments, such as occlusion of the hepatic arterial circulation to the tumor or discontinuation of oral contraceptives, may prove as effective as tumor resection. © 1979, American Medical Association. All rights reserved

The technique of prolonged thoracic duct drainage in transplantation

Prolonged thoracic duct drainage as an immunosuppressive adjunct was accomplished in 96 per cent of organ recipients upon whom it was attempted

Beta-Trace Protein als endogener renaler Biomarker zur Bestimmung der Nierenfunktion bei Individuen im Alter von 70 Jahren und älter

Background The exact measurement of glomerular filtration rate (GFR) is important for diagnostics and therapy of patients with chronic kidney disease. The common used filtration markers creatinine and cystatin C show some disadvantages. Deductive, the ideal endogenous filtration marker has not been identified yet. Especially in the population of the elderly the exact height of GFR is important for clinical decision making and the progress of chronic kidney disease. During the last years, beta-Trace protein (BTP) came up as an alternative endogenous biomarker. In the present work, the question ought to be solved whether BTP serves as an alternative endogenous marker in the prediction of GFR in the elderly (≥ 70 years). Methods In 566 individuals of the Berlin Initiative Study (BIS) (mean age 78.5 years) GFR was measured using Iohexol-plasmaclearance. Creatinine, Cystatin C and BTP were measured in serum. Statistical analyses were performed, correlating the three endogenous biomarker with measured GFR (mGFR) as well as with each other. In a double logarithmic linear model prediction of mGFR using BTP was evaluated. Analyses were performed with BTP only and in combination with creatinine and cystatin C. The model got adjusted for age and gender. Further, the mGFR was compared to results of GFR-estimating equations (eGFR). Subgroup analyses were performed in lean and obese individuals and in individual with diabetes mellitus and arterial hypertension. Results The best correlation was found between Cystatin C and mGFR. The double logarithmic linear model showed the best prediction using the combination of the three biomarkers (r2 = 0,83), but the combination of creatinine and cystatin C was just slightly inferior (r2 = 0,82). Using BTP only showed worst prediction (r2 = 0,67). Within the BTP eGFR-equations, Inker-formula demonstrated the best results. Slight additional benefit using BTP could be found in lean, diabetic and hypertensive individuals. Conclusion Using BTP in the elderly does not outperform the common used endogenous filtration markers creatinine and cystatin C. Particularly cystatin C redundantises the addition of BTP.Einleitung Die exakte Bestimmung der glomerulären Filtrationsrate (GFR) trägt entscheidend zur Diagnostik und Therapie von Patienten mit Nierenerkrankungen bei. Die etablierten endogenen Biomarker Kreatinin und Cystatin C weisen einige Nachteile auf, sodass trotz intensiver Forschung der ideale Biomarker zur Bestimmung der Nierenfunktion noch nicht identifiziert werden konnte. Insbesondere in der älteren Bevölkerung ist die exakte Bestimmung jedoch unerlässlich für wichtige Therapieentscheidungen und die Verlaufsbeurteilung der chronischen Niereninsuffizienz. In den letzten Jahren kam das Beta-Trace Protein (BTP) als Alternative zu den etablierten Biomarkern auf. Ziel der vorliegenden Arbeit ist es, zu überprüfen, ob BTP einen Vorteil bei der Be-stimmung der Nierenfunktion bei Personen über 70 Jahren liefert. Methodik Bei 566 Probanden der Berliner Initiative Studie (BIS) mit einem mittleren Alter von 78,5 Jahren erfolgte die Goldstandardbestimmung der GFR mittels Iohexol-Plasmaclearancemessung. Kreatinin, Cystatin C und BTP wurden im Serum analy-siert. Die statistische Auswertung erfolgte erstens durch eine Korrelationsanalyse, in der die gemessene GFR (mGFR) mit den Biomarkern sowie die Biomarker miteinander korre-liert wurden. Zweitens wurde in einem doppelt linearen logarithmischen Modell die Genauigkeit der Vorhersage der mGFR von BTP überprüft. Die Analysen fanden mit BTP alleine sowie in Kombination mit Kreatinin und Cystatin C statt. Das Modell wurde auf Alter und Geschlecht angepasst. Des Weiteren wurde die mGFR mit den Ergeb-nissen aus GFR-Schätzformeln (estimated GFR (eGFR)) verglichen. Subgruppenana-lysen fanden in schlanken und übergewichtigen Individuen sowie bei Individuen mit arterieller Hypertonie und Diabetes mellitus statt. Ergebnisse In der Korrelationsanalyse zeigte Cystatin C die höchste Korrelation mit der mGFR. In dem doppelt logarithmischen Modell konnte durch die Kombination der drei Biomarker die genaueste Vorhersage der mGFR (r2 = 0,83) getroffen werden, die Kombination aus Kreatinin und Cystatin C zeigte jedoch nur minimal schlechtere Ergebnisse (r2 = 0,82). BTP schnitt als alleiniger Biomarker am schlechtesten ab (r2 = 0,67). Im Ver-gleich der BTP-basierten eGFR-Schätzformeln erzielte die Inker-Formel die besten Ergebnisse. In den Subgruppenanalysen konnte ein minimaler Vorteil bei schlanken Individuen sowie Individuen mit Diabetes mellitus und arterieller Hypertonie festgestellt werden. Schlussfolgerung BTP übertrifft in der Patientengruppe von Personen im Alter von 70 Jahren und älter die etablierten Filtrationsmarker Kreatinin und Cystatin C nicht und liefert keinen Vor-teil bei der Bestimmung der GFR. Insbesondere dem etablierten Cystatin C ist es nicht überlegen