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Hermann HC, Grimm A, Klapp BF, Neuhaus R, Papachristou C. Body Experience After Liver Transplantation: A Body Grid Examination. Journal of Constructivist Psychology 2016. [DOI: 10.1080/10720537.2016.1227736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- H. C. Hermann
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
| | - A. Grimm
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
| | - B. F. Klapp
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
| | - R. Neuhaus
- Department of General, Visceral, and Transplantation Surgery, Charité University Medicine Berlin, Germany
| | - C. Papachristou
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
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Trappe RU, Choquet S, Dierickx D, Mollee P, Zaucha JM, Dreyling MH, Dührsen U, Tarella C, Shpilberg O, Sender M, Salles G, Morschhauser F, Jaccard A, Lamy T, Reinke P, Neuhaus R, Lehmkuhl H, Horst HA, Leithäuser M, Schlattmann P, Anagnostopoulos I, Raphael M, Riess H, Leblond V, Oertel S. International prognostic index, type of transplant and response to rituximab are key parameters to tailor treatment in adults with CD20-positive B cell PTLD: clues from the PTLD-1 trial. Am J Transplant 2015; 15:1091-100. [PMID: 25736912 DOI: 10.1111/ajt.13086] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 10/13/2014] [Accepted: 10/19/2014] [Indexed: 01/25/2023]
Abstract
Tailoring treatment by patient strata based on the risk of disease progression and treatment toxicity might improve outcomes of patients with posttransplant lymphoproliferative disorder (PTLD). We analysed the cohort of 70 patients treated in the international, multicenter phase II PTLD-1 trial (NCT01458548) to identify such factors. Of the previously published scoring systems in PTLD, the international prognostic index (IPI), the PTLD prognostic index and the Ghobrial score were predictive for overall survival. None of the scoring systems had a considerable effect on the risk for disease progression. Age and ECOG performance status were the baseline variables with the highest prognostic impact in the different scoring systems. Baseline variables not included in the scoring systems that had an impact on overall survival and disease progression were the type of transplant and the response to rituximab at interim staging. Thoracic organ transplant recipients who did not respond to rituximab monotherapy were at particularly high risk for death from disease progression with subsequent CHOP-based chemotherapy. Patients in complete remission after four courses of rituximab and patients in partial remission with low-risk IPI had a low risk of disease progression. We speculate that chemotherapy might not be necessary in this patient cohort.
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Affiliation(s)
- R U Trappe
- Department of Internal Medicine II: Hematology and Oncology, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Hematology, Oncology and Tumor Immunology Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
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Fink SEK, Gandhi MK, Nourse JP, Keane C, Jones K, Crooks P, Jöhrens K, Korfel A, Schmidt H, Neumann S, Tiede A, Jäger U, Dührsen U, Neuhaus R, Dreyling M, Borchert K, Südhoff T, Riess H, Anagnostopoulos I, Trappe RU. A comprehensive analysis of the cellular and EBV-specific microRNAome in primary CNS PTLD identifies different patterns among EBV-associated tumors. Am J Transplant 2014; 14:2577-87. [PMID: 25130212 DOI: 10.1111/ajt.12858] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/19/2014] [Accepted: 05/26/2014] [Indexed: 01/25/2023]
Abstract
Primary central nervous system (pCNS) posttransplant lymphoproliferative disorder (PTLD) is a complication of solid organ transplantation characterized by poor outcome. In contrast to systemic PTLD, Epstein-Barr virus (EBV)-association of pCNS PTLD is almost universal, yet viral and cellular data are limited. To identify differences in the pattern of EBV-association of pCNS and systemic PTLD, we analyzed the expression of latent and lytic EBV transcripts and the viral and cellular microRNAome in nine pCNS (eight EBV-associated) and in 16 systemic PTLD samples (eight EBV-associated). Notably although 15/16 EBV-associated samples exhibited a viral type III latency pattern, lytic transcripts were also strongly expressed. Members of the ebv-miR-BHRF1 and ebv-miR-BART clusters were expressed in virtually all EBV-associated PTLD samples. There were 28 cellular microRNAs differentially expressed between systemic and pCNS PTLD. pCNS PTLD expressed lower hsa-miR-199a-5p/3p and hsa-miR-143/145 (implicated in nuclear factor kappa beta and c-myc signaling) as compared to systemic PTLD. Unsupervised nonhierarchical clustering of the viral and cellular microRNAome distinguished non-EBV-associated from EBV-associated samples and identified a separate group of EBV-associated pCNS PTLD that displayed reduced levels of B cell lymphoma associated oncomiRs such as hsa-miR-155, -21, -221 and the hsa-miR-17-92 cluster. EBV has a major impact on viral and cellular microRNA expression in EBV-associated pCNS PTLD.
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Affiliation(s)
- S E K Fink
- Clinical Immunohaematology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Department of Hematology and Oncology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
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Schoening WN, Buescher N, Rademacher S, Andreou A, Kuehn S, Neuhaus R, Guckelberger O, Puhl G, Seehofer D, Neuhaus P. Twenty-year longitudinal follow-up after orthotopic liver transplantation: a single-center experience of 313 consecutive cases. Am J Transplant 2013; 13:2384-94. [PMID: 23915357 DOI: 10.1111/ajt.12384] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/13/2013] [Accepted: 06/12/2013] [Indexed: 02/06/2023]
Abstract
With excellent short-term survival in liver transplantation (LT), we now focus on long-term outcome and report the first European single-center 20-year survival data. Three hundred thirty-seven LT were performed in 313 patients (09/88-12/92). Impact on long-term outcome was studied and a comparison to life expectancy of matched normal population was performed. A detailed analysis of 20-years follow-up concerning overweight (HBMI), hypertension (HTN), diabetes (HGL), hyperlipidemia (HLIP) and moderately or severely impaired renal function (MIRF, SIRF) is presented. Patient and graft survival at 1, 10, 20 years were 88.4%, 72.7%, 52.5% and 83.7%, 64.7% and 46.6%, respectively. Excluding 1-year mortality, survival in the elderly LT recipients was similar to normal population. Primary indication (p < 0.001), age (p < 0.001), gender (p = 0.017), impaired renal function at 6 months (p < 0.001) and retransplantation (p = 0.034) had significant impact on patient survival. Recurrent disease (21.3%), infection (20.6%) and de novo malignancy (19.9%) were the most common causes of death. Prevalence of HTN (57.3-85.2%, p < 0.001), MIRF (41.8-55.2%, p = 0.01) and HBMI (33.2-45%, p = 0.014) increased throughout follow-up, while prevalence of HLIP (78.0-47.6%, p < 0.001) declined. LT has conquered many barriers to achieve these outstanding long-term results. However, much work is needed to combat recurrent disease and side effects of immunosuppression (IS).
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Schmieder R, Puehler F, Neuhaus R, Mumberg D, Ziegelbauer K, Scholz A. 959 The MEK Inhibitor BAY 86-9766 Prolongs Survival in Orthotopic, Syngeneic Animal Models of Hepatocellular Carcinoma and Pancreatic Cancer. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Eurich D, Boas-Knoop S, Yahyazadeh A, Neuhaus R, Somasundaram R, Ruehl M, Puhl G, Neuhaus P, Neumann UP, Bahra M. Role of mannose-binding lectin-2 polymorphism in the development of acute cellular rejection after transplantation for hepatitis C virus-induced liver disease. Transpl Infect Dis 2012; 14:488-95. [PMID: 22650645 DOI: 10.1111/j.1399-3062.2012.00747.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/26/2011] [Accepted: 01/21/2012] [Indexed: 01/13/2023]
Abstract
UNLABELLED The development of liver and graft disease is suspected to be affected by genetic diversity. Mannose-binding lectin-2 (MBL-2) is an important immunomodulatory factor that is involved in complement activation. The aim of our study was to elucidate the role of MBL-2 genotypes after liver transplantation (LT) for hepatitis C virus (HCV)-induced liver disease regarding the incidence of acute cellular rejection (ACR), graft inflammation, fibrosis development, and antiviral treatment response. METHODS A group of 149 patients who underwent LT for HCV-induced liver disease were genotyped for MBL-2 (rs7096206; G/C) by TaqMan genotyping assay. We evaluated 518 post-LT protocol biopsies and at least 98 urgent liver biopsies regarding graft fibrosis stages, inflammation grades, and evidence for rejection within MBL-2 genotype groups. RESULT No association of MBL-2 polymorphisms was observed regarding inflammation, fibrosis, and antiviral treatment outcome. However, the C allele of the MBL-2 gene (P = 0.001) and gender compatibility (P = 0.012) were factors significantly associated with the incidence of ACR. CONCLUSION MBL-2 polymorphisms and gender are involved in the development of ACR after LT. CC genotype and gender match may be regarded as risk factors for ACR in HCV-positive graft recipients. Further studies are needed to confirm and verify this observation in non-HCV groups as well.
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Affiliation(s)
- D Eurich
- Department of General, Visceral and Transplantation Surgery, Charité Campus Virchow, Berlin, Germany.
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Schlosser B, Stein A, Neuhaus R, Pahl S, Ramez B, Krüger DH, Berg T, Hofmann J. Liver transplant from a donor with occult HEV infection induced chronic hepatitis and cirrhosis in the recipient. J Hepatol 2012; 56:500-2. [PMID: 21798217 DOI: 10.1016/j.jhep.2011.06.021] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 06/02/2011] [Accepted: 06/07/2011] [Indexed: 02/07/2023]
Abstract
Acute hepatitis E virus (HEV) infection is a self-limiting symptomatic or asymptomatic disease. However, as recently observed, it can manifest itself as chronic hepatitis in patients receiving solid organ transplants as well as in patients with HIV infection or severe hematologic disorders. Here, we describe the clinical course of a 73-year-old male patient in whom HEV transmission occurred after receiving a HEV-infected liver from a donor with occult HEV infection, whereby the patient had tested negative for HEV RNA and anti-HEV antibodies shortly before explantation. Anti-HEV IgG, IgM, and HEV RNA were detected in the first tested serum sample of the liver recipient obtained 150 days after liver transplantation and remained positive (earlier samples after OLT were not available). Liver cirrhosis developed within 15 months and the patient died of septic shock. Based on phylogenetic analyses of the donor and recipient's HEV strains, we were able to prove that the occult HEV infection was transmitted via the graft.
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Affiliation(s)
- B Schlosser
- Department of Gastroenterology and Hepatology, Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany
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Seehofer D, Rayes N, Neuhaus R, Berg T, Müller A, Bechslein W, Neuhaus P. Antiviral combination therapy for lamivudine-resistant hepatitis B reinfection after liver transplantation. Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02060.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pfiffer TE, Seehofer D, Nicolaou A, Neuhaus R, Riess H, Neuhaus P, Trappe R. Relapse of hepatocellular carcinoma (HCC) after liver transplantation (LT): A single-center analysis on 139 patients in the sorafinib era. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chesi C, Günther M, Huzly D, Neuhaus R, Reinke P, Engelmann H, Mockenhaupt F, Bienzle U. Immunization of liver and renal transplant recipients: a seroepidemiological and sociodemographic survey. Transpl Infect Dis 2009; 11:507-12. [DOI: 10.1111/j.1399-3062.2009.00436.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Schäcke H, Zollner TM, Döcke WD, Rehwinkel H, Jaroch S, Skuballa W, Neuhaus R, May E, Zügel U, Asadullah K. Characterization of ZK 245186, a novel, selective glucocorticoid receptor agonist for the topical treatment of inflammatory skin diseases. Br J Pharmacol 2009; 158:1088-103. [PMID: 19422381 DOI: 10.1111/j.1476-5381.2009.00238.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Glucocorticoids are highly effective in the therapy of inflammatory diseases. Their value, however, is limited by side effects. The discovery of the molecular mechanisms of the glucocorticoid receptor and the recognition that activation and repression of gene expression could be addressed separately opened the possibility of achieving improved safety profiles by the identification of ligands that predominantly induce repression. Here we report on ZK 245186, a novel, non-steroidal, low-molecular-weight, glucocorticoid receptor-selective agonist for the topical treatment of inflammatory dermatoses. EXPERIMENTAL APPROACH Pharmacological properties of ZK 245186 and reference compounds were studied in terms of their potential anti-inflammatory and side effects in functional bioassays in vitro and in rodent models in vivo. KEY RESULTS Anti-inflammatory activity of ZK 245186 was demonstrated in in vitro assays for inhibition of cytokine secretion and T cell proliferation. In vivo, using irritant contact dermatitis and T cell-mediated contact allergy models in mice and rats, ZK 245186 showed anti-inflammatory efficacy after topical application similar to the classical glucocorticoids, mometasone furoate and methylprednisolone aceponate. ZK 245186, however, exhibits a better safety profile with regard to growth inhibition and induction of skin atrophy after long-term topical application, thymocyte apoptosis, hyperglycaemia and hepatic tyrosine aminotransferase activity. CONCLUSIONS AND IMPLICATIONS ZK 245186 is a potent anti-inflammatory compound with a lower potential for side effects, compared with classical glucocorticoids. It represents a promising drug candidate and is currently in clinical trials.
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Affiliation(s)
- H Schäcke
- Bayer Schering Pharma, Global Drug Discovery, Berlin, Germany.
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Storm C, Bernhardt WM, Schaeffner E, Neuhaus R, Pascher A, Neuhaus P, Hasper D, Frei U, Kahl A. Immediate Recovery of Renal Function After Orthotopic Liver Transplantation in a Patient With Hepatorenal Syndrome Requiring Hemodialysis for More Than 8 Months. Transplant Proc 2007; 39:544-6. [PMID: 17362778 DOI: 10.1016/j.transproceed.2006.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Severe liver dysfunction may lead to impairment of renal function without an underlying renal pathology. This phenomenon is called hepatorenal syndrome (HRS), which is associated with a poor prognosis showing a median survival of less than 2 months if renal replacement therapy is necessary. Liver transplantation is the best therapeutic option to regain renal function, but because of poor survival, these patients often die before transplantation. Herein we report a 37-year-old patient with ethyl-toxic liver cirrhosis who underwent hemodialysis due to HRS type I for more than 8 months. After living donor liver transplantation, diuresis immediately resumed, renal function soon recovered, and intermittent hemodialysis was stopped at 18 days after transplantation. Renal function was stable with a serum creatinine <2 mg/dL during the last 5 years posttransplantation. As far as we know, only a few cases of an anuric patient suffering from HRS have been reported with a survival beyond 8 months and full recovery of renal function after liver transplantation. This underlined that renal replacement therapy in HRS should be considered as a possible bridging method to liver transplantation even for longer periods.
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Affiliation(s)
- C Storm
- Department of Nephrology and Medical intensive care, Charit-Campus Virchow, University Hospital of Humboldt-University Berlin, Berlin, Germany.
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Jina E, Büchi S, Neuhaus R, Mörgeli HP, Bucher HU, Fauchère JC. Unterstützung von Eltern extrem frühgeborener Kinder während und nach der Hospitalisation – eine retrospektive Untersuchung. Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-946183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Neuhaus R, Schwink C. On the flow stress of [100]- and [111]-oriented Cu-Mn single crystals: A transmission electron microscopy study. ACTA ACUST UNITED AC 2006. [DOI: 10.1080/01418619208205617] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Junge G, Schewior LV, Kohler S, Neuhaus R, Langrehr JM, Tullius S, Kahl A, Frei U, Neuhaus P. Acute renal failure after liver transplantation: incidence, etiology, therapy, and outcome. Transplant Proc 2006; 38:723-4. [PMID: 16647455 DOI: 10.1016/j.transproceed.2006.01.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute renal failure (ARF) was a frequent complication after orthotopic liver transplantation (OLT) when ARF was defined by a calculated glomerular filtration rate decrease of >50% or by a doubled serum creatinine above 2.5 mg/dL within the first week after OLT. We analyzed 1352 liver transplant recipients in retrospective fashion with regard to the incidence, etiology, therapy, and outcome of ARF; 162 patients developed ARF within the first week after OLT (12%), among whom 157 patients (97%) were recompensated by postoperative day 28. Altogether 52 patients (32%) received an average of 6 hemodialysis treatments, excluding the 5 patients (3%) who developed end-stage renal failure. Risk factors for this complication included hepatorenal syndrome type II, a glomerular filtration rate of <50 mL/min, and a diagnosis of hepatitis C.
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Affiliation(s)
- G Junge
- Klinik f. Allgemein-, Viszeral- und Transplantationschirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
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Jina E, Büchi S, Neuhaus R, Mörgeli HP, Bucher HU, Fauchère JC. Unterstützung von Eltern extrem frühgeborener Kinder während und nach der Hospitalisation – eine retrospektive Untersuchung. Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-943268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Scheifele C, Reichart PA, Hippler-Benscheidt M, Neuhaus P, Neuhaus R. Incidence of oral, pharyngeal, and laryngeal squamous cell carcinomas among 1515 patients after liver transplantation. Oral Oncol 2006; 41:670-6. [PMID: 15979929 DOI: 10.1016/j.oraloncology.2005.03.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 03/29/2005] [Indexed: 01/27/2023]
Abstract
The purpose of this study was to evaluate the incidence and basic characteristics of oral, pharyngeal, and laryngeal squamous cell carcinomas (OPLC) in a single-centre series of liver transplantations (LT). The medical records of 1515 LT cases with a median follow-up of 6 years were analysed retrospectively for incident cases of OPLC. Incidence rates for the oral cavity and pharynx (ICD-9: 141-149), and larynx (ICD-9: 161) were assessed separately. OPLC cases and non-cases were evaluated with regard to end-stage alcoholic liver disease (ALD) as LT indication, smoking, and immunosuppression. The cumulative incidence of 13 cases with OPLC was 0.86% in total (n=1515). For 11 cases of OPLC in 307 patients with LT for ALD, it was 3.58%. The estimates for the annual incidence of OPLC (ICD-9: 141-149) were 121.79 for females and 111.65 for males (/100.000 patient-years). For OPLC (ICD-9: 161), the estimate was 37.21 for males, respectively (no female cases). ALD (84.6%) and pre-LT smoking (92.3%) were significantly overrepresented in OPLC cases (p<0.001). Age and gender distribution were comparable to non-cases. The 5-year survival rate after OPLC was 41.5%. OPLC were demonstrated as a late-onset complication of LT with poor prognosis. The impact of pre-, post-LT smoking, and, in particular, ALD as a confounder of OPLC deserves further investigation.
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Affiliation(s)
- C Scheifele
- Department of Oral Surgery and Dental Radiology, Zentrum für Zahnmedizin, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Junge G, Tullius SG, Klitzing V, Schewior L, Pratschke J, Radke C, Neuhaus R, Neuhaus P. The influence of late acute rejection episodes on long-term graft outcome after liver transplantation. Transplant Proc 2005; 37:1716-7. [PMID: 15919442 DOI: 10.1016/j.transproceed.2005.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acute cellular rejection represents the most important single risk factor for the occurrence of chronic rejection after organ transplantation. We correlated late acute rejections with the occurrence of chronic graft failure after liver transplantation. We followed 1426 liver transplants for late acute rejection episodes defined as occurring >3 months after OLT. The overall incidence of chronic rejection in our patient population was 3.7%. In summary, we observed a predictive increase of transaminase levels prior to routine biopsies among patients with histologic evidence of late acute rejections. In contrast to other organ systems, late acute rejection episodes were not associated with the occurrence of chronic graft deterioration in liver grafts.
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Affiliation(s)
- G Junge
- Klinik f. Allgemein-, Viszeral- und Transplantationschirurgie, Charité Berlin Campus Virchow Klinikum, Berlin, Germany
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Junge G, Neuhaus R, Schewior L, Klupp J, Guckelberger O, Langrehr JM, Tullius S, Neuhaus P. Withdrawal of steroids: a randomized prospective study of prednisone and tacrolimus versus mycophenolate mofetil and tacrolimus in liver transplant recipients with autoimmune hepatitis. Transplant Proc 2005; 37:1695-6. [PMID: 15919434 DOI: 10.1016/j.transproceed.2005.03.145] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this study was to evaluate the success of steroid (PRED) withdrawal due to replacement by mycophenolate mofetil (MMF) in orthotopic liver transplant (OLT) recipients with autoimmune hepatitis (AIH). Thirty patients with AIH > 12 months after OLT randomized to receive either PRED and tacrolimus (TAC) or MMF and TAC were followed for 24 months. Withdrawal of steroids showed no difference regarding graft and patient survival. Also we demonstrated significantly lower glucose levels with lower HbA1c and a reduced need for insulin as well as a significantly lower serum cholesterol in the MMF group. Patients without steroids showed a lower incidence of osteopenia. Maintenance therapy in OLT patients with AIH may be performed safely using MMF instead of prednisone.
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Affiliation(s)
- G Junge
- Klinik f. Allgemein-, Viszeral- und Transplantationschirurgie, Charité Berlin Campus Virchow Klinikum, Berlin, Germany
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Jonas S, Neuhaus R, Junge G, Klupp J, Theruvat T, Langrehr JM, Settmacher U, Neuhaus P. Primary immunosuppression with tacrolimus after liver transplantation: 12-years follow-up. Int Immunopharmacol 2005; 5:125-8. [PMID: 15589470 DOI: 10.1016/j.intimp.2004.09.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The early safety and efficacy of tacrolimus after liver transplantation has been shown in two multicenter trials. Herein, we report our single-center long-term follow-up of a randomized controlled trial. As part of a European multicenter trial, 121 patients entered the study at our institution and were randomly assigned to receive either tacrolimus and steroids (n=61) or a quadruple protocol (n=60) using ciclosporin A, steroids, azathioprine, and antithymocyte globulin (ATG). Twelve-year figures of patient survival were 74% in the tacrolimus group and 66% in the cyclosporine-based group. Graft survival after 12 years was 69% in the tacrolimus group compared to 56% in the cyclosporin-based group (not significant, p=0.15). The total rate of graft loss and retransplantation decreased significantly in the tacrolimus arm (p<0.05). De novo malignancies increased significantly in the ciclosporin-based group and dominated as single cause of death beyond 5 years posttransplant. The use of tacrolimus after liver transplantation resulted in a decreased rate of graft loss over the long-term. An increased number of de novo malignancies in the ciclosporin-based group may be attributable to the use of ATG as induction therapy.
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Affiliation(s)
- S Jonas
- Department of General, Visceral and Transplantation Surgery, Charité Virchow-Klinikum, University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Pfitzmann R, Klupp J, Langrehr JM, Neuhaus R, Junge G, Settmacher U, Steinmüller T, Neuhaus P. Mycophenolate mofetil reduces calcineurin inhibitor-induced side effects after liver transplantation. Transplant Proc 2002; 34:2936-7. [PMID: 12431664 DOI: 10.1016/s0041-1345(02)03495-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R Pfitzmann
- Department of Surgery, Charité, Virchow-Klinikum, Humboldt-University Berlin, Berlin, Germany
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24
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Bahra M, Neumann UP, Harren M, Jacob D, Langrehr JM, Berg T, Neuhaus R, Neuhaus P. Significance of mycophenolate mofetil treatment in patients with HCV reinfection after liver transplantation: impact on clinical course and histologic damage. Transplant Proc 2002; 34:2934-5. [PMID: 12431663 DOI: 10.1016/s0041-1345(02)03494-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Bahra
- Department of Surgery, Charité Campus Virchow-Klinikum, Humboldt-University, Berlin, Germany.
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25
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Pfitzmann R, Klupp J, Langrehr JM, Neuhaus R, Junge G, Settmacher U, Steinmüller T, Neuhaus P. Mycophenolate mofetil for treatment of ongoing or chronic rejections after liver transplantation. Transplant Proc 2002; 34:2938-9. [PMID: 12431665 DOI: 10.1016/s0041-1345(02)03496-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Pfitzmann
- Department of Surgery, Charité, Virchow-Klinikum, Humboldt-University Berlin, Berlin, Germany
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26
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Seehofer D, Rayes N, Steinmüller T, Neuhaus R, Berg T, Müller AR, Neuhaus P. Liver transplantation in hepatitis B patients with preoperative resistance formation during lamivudine treatment. Transplant Proc 2002; 34:2274-5. [PMID: 12270395 DOI: 10.1016/s0041-1345(02)03232-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D Seehofer
- Department of General-Surgery, Charité Campus Virchow, Humboldt University of Berlin, Berlin, Germany
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27
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Seehofer D, Rayes N, Steinmüller T, Müller AR, Jonas S, Settmacher U, Neuhaus R, Berg T, Neuhaus P. Combination prophylaxis with Hepatitis B immunoglobulin and lamivudine after liver transplantation minimizes HBV recurrence rates unless evolution of pretransplant lamivudine resistance. Z Gastroenterol 2002; 40:795-9. [PMID: 12215948 DOI: 10.1055/s-2002-33874] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Survival rates of hepatitis B patients after liver transplantation improved significantly by introduction of passive immunoprophylaxis. Due to viral escape mutations recurrence still occurs, but recently a combination prophylaxis with hepatitis B immunoglobuline plus lamivudine is evaluated in transplant centers in terms of a further reduction of recurrence rates. PATIENTS AND METHODS Between 1996 and 2000 a postoperative combination prophylaxis with HBIg and lamivudine was initiated in 44 HBsAg positive liver transplant recipients. In total 14 patients were HBV-DNA negative and 30 were HBV-DNA positive at the time of evaluation. In 22 HBV-DNA positive patients a pre-operative lamivudine treatment (150 mg/die) was started. Five of them developed pre-transplant lamivudine resistance with high viral replication (mean HBV-DNA prior to transplantation 728 +/- 219 pg/ml). In all patients passive immunoprophylaxis was started in the anhepatic phase with application of 10.000 units hepatitis B immunoglobuline. It was continued after seroconversion to HBsAg negativity with an aimed titer of more than 100 U/l and only stopped in case of HBV recurrence. Lamivudine was also continued indefinitely after liver transplantation. RESULTS Overall recurrence rate in the 44 patients, including retransplantations and patients with pretransplant lamivudine resistance, was 11.5 % under combination prophylaxis. Recurrence was seen only in one of 39 patients (2.6 %) without preoperative lamivudine resistance, in contrast 4 out of 5 patients (80 %) with pre-existing lamivudine resistance suffered from early hepatitis B recurrence. The single patient without preoperative lamivudine resistance, who developed recurrence was pre-transplant HBV-DNA negative without lamivudine treatment, but a postoperative seroconversion to negative HBsAg could not be achieved. The overall 3 year patient survival rate was 91 % in the study population. One patient, who was retransplanted with preoperative lamivudine resistance, died 4.5 months after retransplantation due to hepatitis B recurrence and sepsis, three other patients died for reasons not related to hepatitis B recurrence. Combination prophylaxis was well tolerated in all patients and no severe side effects were observed. CONCLUSION Combination prophylaxis with hepatitis B immunoglobulin and lamivudine is safe and highly effective in prevention of HBV recurrence after liver transplantation, even in case of positive viral replication. In accordance with the results of other centers it should therefore be the standard regimen. However it fails in the majority of patients with preoperative evolution of YMDD mutations, in which the optimal management has to be determined yet. To minimize preoperative resistance formation universal preoperative antiviral treatment of HBV-DNA positive patients should be replaced by individualized indication for preoperative treatment.
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Affiliation(s)
- D Seehofer
- Department of General-, Visceral- and Transplant-Surgery, Charité Campus Virchow, Humboldt University of Berlin, Germany.
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Schumacher G, Oidtmann M, Rosewicz S, Langrehr J, Jonas S, Mueller AR, Rueggeberg A, Neuhaus R, Bahra M, Jacob D, Gerlach H, Neuhaus P. Sirolimus inhibits growth of human hepatoma cells in contrast to tacrolimus which promotes cell growth. Transplant Proc 2002; 34:1392-3. [PMID: 12176410 DOI: 10.1016/s0041-1345(02)02899-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- G Schumacher
- Department of General-, Visceral-, and Transplantation Surgery, Charité Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
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29
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Junge G, Neumann UP, Joka M, Nagy M, Neuhaus R, Langrehr JM, Neuhaus P. Microchimerism in patients after orthotopic liver transplantation: a prognostic indicator? Transplant Proc 2002; 34:1542-3. [PMID: 12176475 DOI: 10.1016/s0041-1345(02)03012-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Guido Junge
- Department of Surgery and Transplantation, Charité Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
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30
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Walter M, Scholler G, Moyzes D, Hildebrandt M, Neuhaus R, Danzer G, Klapp BF. Psychosocial prediction of abstinence from ethanol in alcoholic recipients following liver transplantation. Transplant Proc 2002; 34:1239-41. [PMID: 12072327 DOI: 10.1016/s0041-1345(02)02741-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M Walter
- Clinic for Internal Medicine-Psychosomatics/Psychotherapy, Charité, Campus Virchow, Humboldt-University Berlin, Berlin, Germany.
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31
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Seehofer D, Rayes N, Steinmüller T, Müller AR, Settmacher U, Neuhaus R, Radke C, Berg T, Hopf U, Neuhaus P. Occurrence and clinical outcome of lamivudine-resistant hepatitis B infection after liver transplantation. Liver Transpl 2001; 7:976-82. [PMID: 11699034 DOI: 10.1053/jlts.2001.28442] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lamivudine treatment of hepatitis B after orthotopic liver transplantation (OLT) is often accompanied by fast viral-resistance formation. Although no clinical data are available, in vitro data indicate that lamivudine-resistant reinfection has a mild course because of defective viral replication. Between 1996 and 1999, a total of 34 patients were treated with lamivudine because of hepatitis B recurrence after OLT. All patients developed reinfection despite long-term passive immunoprophylaxis with hepatitis B immunoglobulin, diagnosed by positive hepatitis B surface antigen and positive hepatitis B virus (HBV) DNA. Before treatment with lamivudine, 21 of these patients underwent a course of famciclovir and developed resistance. Monthly laboratory tests and sequential liver biopsies were performed during the follow-up period. Nineteen of 34 patients (56%) developed lamivudine resistance during the follow-up period of 12 to 49 months. One- and 3-year graft survival rates after the diagnosis of lamivudine resistance were 89% and 66%, respectively. In most cases, lamivudine resistance was associated with high viral replication (3,012 +/- 574 pg/mL 1 month after the diagnosis of lamivudine resistance); however, liver enzyme levels were only moderately elevated (alanine aminotransferase [ALT], 45 +/- 16 U/L). Only 3 patients (15%) showed a rapid increase in ALT level to more than 500 U/L within 3 months after resistance developed. All other patients had mildly elevated liver enzyme levels during the first 6 to 8 months after lamivudine resistance. In the later course, liver enzyme levels increased in most patients. Fourteen patients with elevated transaminase levels were switched to lamivudine plus interferon alfa (n = 8) or lamivudine plus famciclovir therapy (n = 6). This combination was successful in most cases, decreasing HBV DNA and liver enzyme levels. Four patients with lamivudine resistance died during follow-up, only 1 patient because of HBV reinfection. In addition, 2 patients underwent retransplantation because of hepatitis B cirrhosis of the first graft. Compared with historic courses of wild-type recurrence, lamivudine-resistant reinfection is characterized by a milder clinical course. Fulminant cases were not observed; however, in three cases, chronic liver failure developed. The combination of different antivirals diminished viral replication after lamivudine resistance. In the future, new antiviral agents, such as adefovir, might further expand therapeutic options.
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Affiliation(s)
- D Seehofer
- Department of General, Visceral, and Transplant Surgery, Campus Virchow, Humboldt University of Berlin, Germany.
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32
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Ott R, Bussenius-Kammerer M, Scholz D, Neuhaus R, Tolba RH, Fricke L, Müller V. Conversion from tacrolimus to Neoral in liver and kidney transplant recipients. Transplant Proc 2001; 33:3166-8. [PMID: 11750359 DOI: 10.1016/s0041-1345(01)02348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- R Ott
- Department of Surgery, University of Erlangen, Erlangen, Germany
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33
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Seehofer D, Rayes N, Naumann U, Neuhaus R, Müller AR, Tullius SG, Berg T, Steinmüller T, Bechstein WO, Neuhaus P. Preoperative antiviral treatment and postoperative prophylaxis in HBV-DNA positive patients undergoing liver transplantation. Transplantation 2001; 72:1381-5. [PMID: 11685107 DOI: 10.1097/00007890-200110270-00008] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite passive immunoprophylaxis a significant number of patients, especially if hepatitis B virus (HBV) DNA is positive prior to transplantation, develop HBV recurrence. This number might be reduced by lowering viral replication pretransplant with antiviral agents and by postoperative combination of antiviral agents and passive immunoprophylaxis. PATIENTS AND METHODS A total of 74 HBV-DNA positive patients who underwent liver transplantation between 9/88 and 4/00 were analyzed retrospectively. Before lamivudine or famciclovir were available, in total 40 patients did not receive any preoperative antiviral therapy. Since 11/93, 17 patients were treated with famciclovir 1500 mg daily, after 4/96 17 patients with lamivudine 150 mg daily prior liver transplantation. Posttransplant all patients received passive immunoprophylaxis aiming at a titer of more than 100 U/liter. In the 34 patients with preoperative antiviral therapy an additional prophylaxis with the respective antiviral agent was applied. RESULTS Under preoperative famciclovir and lamivudine 30 and 71% of patients became HBV-DNA negative, respectively. Actuarial reinfection rate 2 years after liver transplantation was 48% without antiviral prophylaxis, which was not statistically different from 55% under perioperative famciclovir therapy. In contrast only 18% developed HBV recurrence under perioperative lamivudine treatment. During both antiviral regimens neither pre nor posttransplant severe side effects were observed. CONCLUSION Perioperative application of famciclovir is not recommendable, whereas lamivudine seems to lower recurrence rates significantly. Whether the observed effect is due to pre- or postoperative application remains to be addressed in further studies. In addition the long-term course has to be awaited.
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Affiliation(s)
- D Seehofer
- Department of Visceral and Transplant Surgery, Charité Campus Virchow, Augustenburger Platz 1, D-13353 Berlin, Germany
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34
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Langrehr JM, Klupp J, Junge G, Jonas S, Neuhaus R, Bechstein WO, Neuhaus P. Quadruple versus dual tacrolimus-based induction after liver transplantation: a prospective, randomized trial. Transplant Proc 2001; 33:2330-1. [PMID: 11377549 DOI: 10.1016/s0041-1345(01)02011-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J M Langrehr
- Department of Surgery, Charité, Campus Virchow-Klinikum, Humboldt University-Berlin, Berlin, Germany
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35
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Pfitzmann R, Heise M, Langrehr JM, Jonas S, Steinmüller T, Podrabsky P, Ewert R, Settmacher U, Neuhaus R, Neuhaus P. Liver transplantation for treatment of intrahepatic Osler's disease: first experiences. Transplantation 2001; 72:237-41. [PMID: 11477345 DOI: 10.1097/00007890-200107270-00012] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intrahepatic Osler's disease with multiple arteriovenous malformations and high intrahepatic shunting may lead to secondary pulmonary hypertension followed by right-heart stress and insufficiency. Until now, therapy with arterial embolization, banding, or ligation of the hepatic arteries is still limited and provides unsatisfactory long-term results. Liver transplantation offers another therapeutic option. METHODS We report on four patients with intrahepatic involvement of Osler's disease who were liver transplanted between 1995 and 1999. All patients suffered from restricted liver function and right-heart insufficiency with multiple cardiac decompensations. One patient received one course of embolization, and another received six courses of embolization and then banding of the main hepatic artery before transplantation. In both patients, the clinical symptoms improved for only a few months. RESULTS All patients had high degrees of intrahepatic arteriovenous shunting, and cardiac output measurements were between 8.0 to 13.3 L/min preoperatively. Preoperative mean pulmonary artery pressure was between 24 to 35 mmHg. After liver transplantation, cardiac output and right-heart diameter decreased or normalized and pulmonary pressure reached the normal range after 2 months. All patients received tacrolimus and steroids for primary immunosuppression. In one case, temporary hemodialysis was necessary for 2 weeks after transplantation, but renal function recovered completely. After follow-up time of 12 to 65 months, all patients had normal graft function and good cardiopulmonary condition. CONCLUSIONS Indication for liver transplantation should be considered in patients with intrahepatic Osler's disease, high arteriovenous shunting with right-heart stress, and restricted liver function before irreversible fixed pulmonary hypertension leads to severe right-heart insufficiency or failure. Our therapeutic regimen of early liver transplantation in the case of intrahepatic Osler's disease in four patients has promising results.
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Affiliation(s)
- R Pfitzmann
- Department of General, Visceral, and Transplantation Surgery, Charité, Campus Virchow-Klinikum, Humboldt-University Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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36
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Seehofer D, Rayes N, Neuhaus R, Berg T, Müller AR, Bechstein WO, Neuhaus P. Antiviral combination therapy for lamivudine-resistant hepatitis B reinfection after liver transplantation. Transpl Int 2001; 13 Suppl 1:S359-62. [PMID: 11112032 DOI: 10.1007/s001470050361] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Development of resistance is a major issue in antiviral treatment of hepatitis B reinfection after liver transplantation. Antiviral combination therapy is discussed for therapy or prevention of this breakthrough of viral replication. Eight patients were enrolled into this retrospective analysis after liver transplantation for chronic hepatitis B infection. All had reinfection of the graft and breakthrough of HBV during consecutive famciclovir and lamivudine monotherapy. Subsequently a combination therapy with lamivudine and interferon-alpha 2a (group I, n = 4) or lamivudine and famciclovir (group II, n = 4) was initiated. Combination therapy was started 61 months (group I) and 25 months (group II) after liver transplantation. It markedly reduced the viral replication rate in all patients despite lamivudine resistance. In group I three of four patients and in group II two of four patients became HBV-DNA negative. Two long-term responders were observed in group I, and none in group II. No patient became HBsAg negative or lost HbeAg. Pretreatment elevated ALT and AST levels were significantly reduced. No severe complications, and especially no rejection episodes, occurred. Lamivudine in combination with other antiviral agents, especially interferon-alpha, might be a therapeutic option for hepatitis B reinfection after liver transplantation. Suppression of virus replication to the point of undetectable values is possible even in patients with lamivudine-resistant virus mutations.
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Affiliation(s)
- D Seehofer
- Department of General-Visceral and Transplant Surgery, Humboldt University of Berlin, Germany
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37
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Langrehr JM, Lohmann R, Raakow R, Jonas S, Klupp J, Bechstein WO, Neuhaus R, Neuhaus P. Chronic rejection after orthotopic liver transplantation is increased under induction therapy with interleukin-2 receptor antibody BT563. Transplant Proc 2001; 33:2290-1. [PMID: 11377531 DOI: 10.1016/s0041-1345(01)01993-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- J M Langrehr
- Department of Surgery, Charité Campus Virchow-Klinikum, Humboldt University, Berlin, Germany
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38
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Seehofer D, Rayes N, Berg T, Neuhaus R, Müller AR, Hopf U, Bechstein WO, Neuhaus P. Lamivudine as first- and second-line treatment of hepatitis B infection after liver transplantation. Transpl Int 2001; 13:290-6. [PMID: 10959482 DOI: 10.1007/s001470050704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lamivudine and famciclovir have expanded therapeutical options for HBV infection after liver transplantation. First studies confirm good antiviral effects of both, but at present the major problem seems to be a rapid resistance formation in immunosuppressed patients. Thirty-four adult patients with HBV recurrence despite passive immunoprophylaxis and seven with de novo infection after orthotopic liver transplantation (OLT) were treated with 100-150 mg lamivudine daily. Patients were either treated directly after infection (n = 14) or after breakthrough of viral replication during an initial famciclovir therapy (n = 27). All patients except two responded to treatment with a reduction of serum HBV-DNA of over 50%. Thirty-one patients (76%) turned HBV-DNA-negative during lamivudine therapy. Viral breakthrough was observed in 14 of these patients after 4-13 months of treatment. A total of 17 patients (40%) remained HBV-DNA-negative for more than 12 months. Only nine patients eliminated HBsAg, of which four had and an HDV coinfection. None of the HBeAg-positive patients converted to anti-HBe. Most patients showed a prompt and significant reduction of aspartate aminotransferase (ALAT) levels. No severe complications occurred. Therefore, a safe and effective therapy of HBV infection after transplantation is possible with lamivudine. Viral replication is suppressed even in patients who revealed breakthrough during famciclovir therapy. Resistance formation as a major drawback occurred in one third of the patients within the first year of treatment.
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Affiliation(s)
- D Seehofer
- Department of General-, Visceral- and Transplant Surgery, Humboldt University of Berlin, Germany
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39
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Günther M, Stark K, Neuhaus R, Reinke P, Schröder K, Bienzle U. Rapid decline of antibodies after hepatitis A immunization in liver and renal transplant recipients. Transplantation 2001; 71:477-9. [PMID: 11233913 DOI: 10.1097/00007890-200102150-00023] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hepatitis A vaccine is safe and achieves good seroconversion rates in liver (LTX) and renal (RTX) transplant recipients. METHODS A study was performed to determine the anti-hepatitis A virus (HAV) antibody decline in LTX and RTX patients, and in healthy controls who have been immunized with two doses of hepatitis A vaccine. RESULTS LTX and RTX patients had a satisfactory seroconversion rate after complete immunisation. However, 2 years later they had experienced a much more rapid antibody decline than controls, and only 59% of LTX and 26% of RTX seroconverters showed titres above the cut-off level defined as protective. CONCLUSIONS Patients on immunosuppressive therapy may not be adequately protected against hepatitis A a few years after vaccination and alternative vaccination schemes may have to be considered.
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Affiliation(s)
- M Günther
- Institute of Tropical Medicine, Department of Surgery, Charité, Humboldt University of Berlin, Centre for Hemodialysis, Germany
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40
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Mueller AR, Platz K, Willimski C, Berg T, Steinmüller T, Neumann U, Neuhaus R, Hopf U, Radke C, Neuhaus P. Influence of immunosuppression on patient survival after liver transplantation for hepatitis C. Transplant Proc 2001; 33:1347-9. [PMID: 11267321 DOI: 10.1016/s0041-1345(00)02504-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A R Mueller
- Department of Surgery, Virchow Clinic, Humboldt University of Berlin, Berlin, Germany
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41
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Pfitzmann R, Langrehr JM, Heise M, Steinmüller T, Neuhaus R, Neuhaus P. Successful orthotopic liver transplantation for treatment of intrahepatic Osler's disease. Transplant Proc 2001; 33:1426-7. [PMID: 11267357 DOI: 10.1016/s0041-1345(00)02538-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- R Pfitzmann
- Department of Surgery, Charité, Virchow-Klinikum, Humboldt-University Berlin, Berlin, Germany
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Langrehr JM, Klupp J, Pfitzmann R, Neumann U, Lohmann R, Jonas S, Neuhaus R, Steinmüller T, Neuhaus P. A prospective, randomized trial with quadruple versus dual tacrolimus-based induction after liver transplantation. Transplant Proc 2001; 33:1520. [PMID: 11267404 DOI: 10.1016/s0041-1345(00)02579-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- J M Langrehr
- Department of Surgery, Charité Campus Virchow-Klinikum, Humboldt-University Berlin, Berlin, Germany
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43
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Affiliation(s)
- R Raakow
- Department of Surgery, Charité, Campus Virchow Clinics, Humboldt University Berlin, Berlin, Germany
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44
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Schumacher G, Platz KP, Mueller AR, Neuhaus R, Luck W, Langrehr JM, Settmacher U, Steinmueller T, Becker M, Neuhaus P. Liver transplantation in neurologic Wilson's disease. Transplant Proc 2001; 33:1518-9. [PMID: 11267403 DOI: 10.1016/s0041-1345(00)02578-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G Schumacher
- Department of General-, Visceral-, and Transplantation Surgery, Charité Campus Virchow Klinikum, Berlin, Germany
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Rayes N, Seehofer D, Hopf U, Neuhaus R, Naumann U, Bechstein WO, Neuhaus P. Comparison of famciclovir and lamivudine in the long-term treatment of hepatitis B infection after liver transplantation. Transplantation 2001; 71:96-101. [PMID: 11211203 DOI: 10.1097/00007890-200101150-00016] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preliminary results of short-term famciclovir and lamivudine therapy in patients with hepatitis B virus (HBV) infection after liver transplantation revealed promising results. In a retrospective study the efficacy of long-term treatment with these substances was compared. METHODS A total of 53 HBV-infected adults (48 reinfections and 7 de novo infections) received antiviral treatment. A total of 32 of these patients were treated with famciclovir 3x500 mg, 20 of them were later switched to lamivudine. Fourteen patients received lamivudine, 150 mg/day orally, as first line therapy and 7 patients after failure of famciclovir-prophylaxis. Follow-up time was 8 to 62 months (mean 35 months). Response to therapy (HBV-DNA negative) was compared using Kaplan-Meier estimates. Potential influence factors (HBV-DNA and HBeAg pretransplant, HDV coinfection, pretreatment with famciclovir and immunosuppression) on treatment response were analyzed by log. Rank test (univariate); then a multivariate analysis (Cox multiple stepwise regression model) was applied. RESULTS A total of 19 and 76% of the patients treated with famciclovir and lamivudine resp. became HBV-DNA negative; 0 and 24% HBsAg negative. Lamivudine was also effective as second line therapy. In a multivariate analysis of all 73 treatment courses, lamivudine treatment and HDV-coinfection were significant factors for better treatment response; regarding only the lamivudine group, negative HBeAg pretransplant was significant. Viral breakthrough after prolonged treatment occurred in 55% (lamivudine) to 80% (famciclovir) of treatment courses but was only accompanied by mild hepatitis. CONCLUSIONS Lamivudine and famciclovir are potent drugs for the treatment of HBV-infection after liver transplantation. The antiviral capacity of lamivudine is superior even after pretreatment with famciclovir but after prolonged treatment viral breakthrough is often observed.
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Affiliation(s)
- N Rayes
- Department of Surgery, Humboldt University, Berlin, Germany
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46
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Lohmann R, Langrehr JM, Raakow R, Jonas S, Klupp J, Steinmüller T, Neuhaus R, Neuhaus P. Impact of primary immunosuppression on the incidence of infectious complications after orthotopic liver transplantation. Transplant Proc 2000; 32:2229-30. [PMID: 11120145 DOI: 10.1016/s0041-1345(00)01647-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- R Lohmann
- Department of Surgery, Charité Campus Virchow-Klinikum, Humboldt University Berlin, Berlin, Germany
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47
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Seehofer D, Rayes N, Bechstein WO, Naumann U, Neuhaus R, Berg T, Hopf U, Langrehr JM, Steinmüller T, Platz KP, Müller AR, Neuhaus P. [Therapy of recurrent hepatitis B infection after liver transplantation. A retrospective analysis of 200 liver transplantations based on hepatitis B associated liver diseases]. Z Gastroenterol 2000; 38:773-83. [PMID: 11072673 DOI: 10.1055/s-2000-7528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Before introduction of passive immunoprophylaxis and new antiviral nucleoside analogues the course of hepatitis B recurrence after liver transplantation could hardly be influenced. The result was a inferior graft survival. In the present retrospective analysis of the efficacy of hepatitis B therapy after liver transplantation was analysed retrospectively. PATIENTS AND METHODS Between 1988 and 1998 in total 179 patients were transplanted due to hepatitis B related liver failure at our centre. All patients received passive immunoprophylaxis with hepatitis B immunoglobulin. In case of reinfection after 1993 an antiviral therapy with famciclovir 1500 mg daily was initiated (n = 26), since 1996 lamivudine (100-150 mg daily) was used (n = 12). In case of viral breakthrough under famciclovir treatment or prophylaxis therapy was switched to lamivudine (n = 22). In case of ineffectiveness of lamivudine an antiviral combination therapy with lamivudine and interferon (n = 4) or lamivudine and famciclovir (n = 4) was initiated. Before availability of antiviral agents or in case of viral breakthrough in total 12 patients were retransplanted due to acute or chronic reinfection. RESULTS With passive immunoprophylaxis reinfection rate was 33%, 43% and 44% after 1, 3 and 5 years respectively. Without antiviral treatment 52% of patients died within the first year after reinfection. Antiviral therapy with lamivudine or famciclovir improved the one year survival after reinfection to 79%. Suppression of viral replication was more effective with lamivudine. Under lamivudine 26 patients (76%) became HBV-DNA negative, 9 patients HBsAg negative (26%). In contrast no patient became HBsAg negative during famciclovir therapy. Lamivudine was effective also after famciclovir breakthrough in 94% of patients. In case of lamivudine resistant reinfection viral replication could be suppressed with an antiviral combination therapy up to negative HBV-DNA in the hybridization assay. Severe side effects were not observed during any of the antiviral therapies. The graft survival after retransplantation for hepatitis B reinfection was 42% and 25% after one and 3 years. CONCLUSION Whereas it is generally accepted, that passive immunoprophylaxis lowers the reinfection rate it could be shown in the present study, that antiviral treatment lowers mortality of hepatitis B reinfection. The major problem of lamivudine and famciclovir is viral resistance formation. In this case an antiviral combination therapy might be useful, whereas retransplantation for hepatitis B reinfection should be considered carefully due to inferior graft survival rates.
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Affiliation(s)
- D Seehofer
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Humboldt-Universität zu Berlin.
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48
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Neuhaus P, Klupp J, Langrehr JM, Neumann U, Gebhardt A, Pratschke J, Tullius SG, Lohmann R, Radke C, Rayes N, Neuhaus R, Bechstein WO. Quadruple tacrolimus-based induction therapy including azathioprine and ALG does not significantly improve outcome after liver transplantation when compared with standard induction with tacrolimus and steroids: results of a prospective, randomized trial. Transplantation 2000; 69:2343-53. [PMID: 10868638 DOI: 10.1097/00007890-200006150-00022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tacrolimus in combination with prednisolone has been proven to be a safe and effective immunosuppressive induction therapy in solid organ transplantation. However, it remains unclear whether a tacrolimus-based quadruple induction regimen with azathioprine and an antilymphocytic preparation could further improve the results after orthotopic liver transplantation. Therefore, we designed a prospective, randomized study to compare the immunosuppressive efficacy of dual (tacrolimus and prednisolone) and quadruple (tacrolimus, azathioprine, ALG Merieux and prednisolone) induction after liver transplantation. METHODS After randomization, 120 consecutive patients of primary liver transplants were divided into the dual group (n=59) and the quadruple group (n=61) and followed for a minimum of 3 years. RESULTS Patient survival at 3 years was 88.2% in the dual versus 94.9% in the quadruple group. Overall 25 patients in each group (41 and 42%, respectively) developed acute rejection. There was no difference in the number and severity of rejections. In each group only four patients required OKT3-therapy, however, although three of four patients in the quadruple group responded to OKT3 and cleared rejection, none of the four patients in the dual group were treated successfully with OKT3 (P<0.02). Rejection in these patients resolved only after additional treatment with mycophenolate mofetil. Adverse events and infections were equally distributed in both groups. Asymptomatic Cytomegalovirus infections were more common in the quadruple group (P<0.02). As of today, only one patient developed posttransplant lymphoproliferative disease (dual group). CONCLUSIONS The data from our single-center study indicate that both tacrolimus-based dual and quadruple immunosuppressive induction regimens yield similar safety and effectiveness after liver transplantation.
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Affiliation(s)
- P Neuhaus
- Department of Surgery, Charité Campus Virchow-Klinikum, Humboldt-Universität zu Berlin, Germany
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49
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Lohmann R, Langrehr JM, Raakow R, Neuhaus R, Bechstein WO, Neuhaus P. Long-term survival after orthotopic liver transplantation with regard to country of origin and residence. Transplant Proc 2000; 32:516. [PMID: 10812091 DOI: 10.1016/s0041-1345(00)00868-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- R Lohmann
- Department of Surgery, Charité, Campus Virchow-Klinikum, Humboldt University, Berlin, Germany
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50
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Lohmann R, Langrehr JM, Klupp J, Jonas S, Raakow R, Bechstein WO, Neuhaus R, Neuhaus P. Infectious complications after orthotopic liver transplantation with different immunosuppressive induction regimens. Transplant Proc 2000; 32:537-8. [PMID: 10812102 DOI: 10.1016/s0041-1345(00)00879-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- R Lohmann
- Department of Surgery, Charite, Campus Virchow-Klinikum, Humboldt University, Berlin, Germany
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