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  • 1
    ISSN: 1433-0385
    Keywords: Key words: Liver transplantation ; Quality ; Results ; Small centre. ; Schlüsselwörter: Orthotope Lebertransplantation ; Qualität im kleinen Zentrum ; Langzeitergebnisse.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die orthotope Lebertransplantation ist heute zur Therapie der Wahl der Endstadien verschiedener Lebererkrankungen geworden. International beträgt das perioperative Überleben 80 % und die 5-Jahres-Überlebensrate liegt bei elektiv operierten nicht malignen Erkrankungen über 70 %. Das Lebertransplantationsprogramm in Bern ist im internationalen Vergleich klein und basiert auf dem Routinebetrieb einer Universitätsklinik. Es stellt sich daher die Frage nach den Resultaten und der Daseinsberechtigung eines solchen Programms. Im Zeitraum von 66 Monaten wurden am Inselspital in Bern 62 Lebertransplantationen bei 60 Patienten durchgeführt. Die perioperative Letalität betrug 3,3 %, die 30-Monats-Überlebensrate 92 % (elektive Patienten mit benignen Erkrankungen). 68 % der Patienten sind im Median 30 Monate nach der Transplantation arbeitsfähig und 83 % unabhängig von fremder Hilfe. Diese Resultate über einen 5-Jahres-Zeitraum sind vergleichbar mit den Ergebnissen internationaler Transplantationszentren. Aus unserer Sicht hat ein solches kleines Programm daher, wenn es interdisziplinär im Konzept einer Universitätsklinik eingepaßt ist, Daseinsberechtigung und Perspektive.
    Notes: Summary. Today, orthotopic liver transplantation is the treatment of choice for the end-stage of various liver diseases, and a 1-year survival rate of 80 % and a 5-year survival rate of 70 % in elective patients without tumor are reported in international surveys. The liver transplant programme of the Inselspital in Bern is small compared with international centres, which may raise questions about the results and the justification for such a programme. Over a period of 66 months, 62 liver transplantations were performed in 60 patients at the Inselspital. The hospital mortality was 3.3 %, and the 2.5-year overall survival rate was 92 % for elective cases without tumor. After a median follow-up of 30 months, 68 % of all patients were re-integrated in housework or full- or part-time in their profession, and 83 % were independent from the help of others. We conclude that a small liver transplant programme based only on routine resources can achieve results comparable to the international standards.
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  • 2
    ISSN: 1435-2451
    Keywords: Key words Liver transplantation ; Rejection ; Liver disease ; Primary biliary cirrhosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Graft rejection and infection remain major problems following liver transplantation; both are heavily influenced by the immunosuppressive regimen. Despite the disparity in the primary disease leading to transplantation, all patients receive the same post-transplant immunosuppressive treatment in a given center. The aim of this study is to detect a possible effect of the underlying disease on the incidence of early acute rejection episodes after orthotopic liver transplantation (OLT). Patients and Methods: Retrospective analysis on all 101 consecutive liver transplants performed in 95 patients between 1983 and March 1998; five of these patients, surviving less than 30 days, were not included. The immunosuppressive regimen was based on conventional triple therapy during the whole study period. The diagnosis and treatment of acute rejection within the first 30 days post-OLT was uniform throughout the whole study period. Results: Though there were no differences with respect to patients' characteristics [age, child classification, number of HLA-mismatches or cytomegalovirus (CMV)-serocompatibility], patients with primary biliary cirrhosis (PBC) showed a significant increase of acute rejection after OLT compared with the other patients transplanted for other liver diseases (P = 0.024). The incidence of infection was not elevated in patients transplanted for PBC when compared with other diagnoses. Conclusion: Our results indicate that primary liver disease may be a determinant for acute graft rejection in PBC. Furthermore, these results suggest that immunosuppressive regimens based on the underlying disease should be considered.
    Type of Medium: Electronic Resource
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