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  • Alcohol relapse  (1)
  • Arterial complications  (1)
  • Budd-Chiari-Syndrom.  (1)
  • 1
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Alcoholic cirrhosis ; Alcohol relapse ; Outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Because of the donor shortage, there are concerns for liver transplantation in patients with alcoholic cirrhosis. We therefore analyzed patients transplanted for alcoholic cirrhosis at our center with respect to patient and graft survival, recurrence of disease, and postoperative complications. Out of 1000 liver transplantations performed in 911 patients, 167 patients were transplanted for alcoholic cirrhosis; 91 patients received CsA- and 76 patients FK506-based immunosuppression. Recurrence was diagnosed by patient's or relative's declaration, blood alcohol determination, and delirium. Diagnosis and treatment of acute and chronic rejection was performed as previously described. One- (96.8 % versus 91.3 %) and 9-year patient survival (83.3 % versus 80 %) compared well with other indications. Five of 15 patients died due to disease recurrence. Recurrence of disease was significantly related to the duration of alcohol abstinence prior to transplantation. In patients who were abstinent for less than 6 months (17.1 %), recurrence rate was 65 %, including four of the five patients who died of recurrence. Recurrence rate decreased to 11.8 %, when abstinence time was 6–12 months and to 5.5 %, when the abstinence times was 〉 2 years. Next to duration of abstinence, alcohol relapse was significantly related to sex, social environment, and psychological stability. The incidence of acute rejection compared well with other indications (38.1 %); CsA: 40.1 % versus 33.3 % in FK506 patients. In all, 18.2 % of CsA patients experienced steroid-resistant rejection compared with 2.6 % of FK506 patients. Seven patients (7.6 %) in the CsA group and one patient (1.3 %) in the FK506 group developed chronic rejection. A total of 57.1 % developed infections; 5.7 % were life-threatening. CMV infections were observed in 14.3 % (versus 25 % for other indications). New onset of insulin-dependent diabetes was observed in 8.6 % and hypertension in 32.4 %. In conclusion, alcoholic cirrhosis is a good indication for liver transplantation with respect to graft and patient survival and development of postoperative complications. FK506 therapy was favourable to CsA treatment. Patient selection is a major issue and established criteria should be strictly adhered to. Patients with alcohol abstinence times shorter than 6 months should be excluded, since recurrence and death due to recurrence was markedly increased in this group of patients.
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  • 2
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Arterial complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From September 1988 through April 1998, 1000 liver transplantations were performed on 911 patients. During the postoperative control examinations of 837 patients, we found 23 (2.74 %) with hepatic artery thromboses, 27 stenoses of the hepatic artery (3.22 %), and 6 aneurysms of the graft artery. Seventeen patients underwent retransplantation because of arterial complications. Depending on the clinical symptoms, we treated both the local situation as well as the resulting complications of inadequate arterial graft flow. The aneurysms were primarily treated surgically. The first choice of treatment of stenoses was balloon angioplasty. Early postoperative artery thromboses were also treated surgically by thrombectomy in selected cases. For the resulting biliary and local septic complications we preferred endoscopic and drainage procedures. Our clinical experiences have led us to find pretransplantation angiography recommendable, especially in the case of splanchnic artery stenoses, for bypassing from the aorta for arterial perfusion of the graft.
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  • 3
    ISSN: 1433-0385
    Keywords: Key words: Liver transplantation ; Budd-Chiari syndrome. ; Schlüsselwörter: Lebertransplantation ; Budd-Chiari-Syndrom.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Das Budd-Chiari-Syndrom (BCS) ist eine seltene Krankheit mit Verschluß der Lebervenen, die sowohl in akuten wie auch chronischen lebensbedrohlichen Situationen durch eine orthotope Lebertransplantation behandelt werden kann. Wir berichten über 16 Patienten, die insgesamt 18 Lebertransplantate wegen eines BCS erhielten und mindestens zwei Jahre nachbeobachtet wurden. Bei 7 Patienten lag eine hämatologische Erkrankung zugrunde, die anderen Fälle blieben ätiologisch ungeklärt. Ein Patient verstarb 4 Monate nach Transplantation an einer CMV-Pneumonie, ein weiterer 2 Jahre nach Transplantation an protrahiertem Leberversagen bei Pfortaderthrombose. Die aktuarische 5-Jahres-Überlebensrate beträgt 87,5 %, die aller an unserer Institution durchgeführten 710 Transplantationen von 9/1988 bis 12/1995 liegt bei 85,3 %. Die Rezidivprophylaxe bestand aus Anticoagulation mit Heparin und überlappender Fortsetzung mit Marcumar. Drei Patienten wurden bei Thrombocytose mit Hydroxyharnstoff behandelt, davon einer lediglich für eine Woche in der Frühphase nach Transplantation. Zwei revisionsbedürftige, abdominelle Nachblutungen sind möglicherweise auf die Anticoagulation zurückzuführen. Zwei Patienten mußten retransplantiert werden, der eine wegen Teilthrombose von Leberarterie und Pfortader, nachdem Marcumar bei gastrointestinaler Blutung abgesetzt worden war, der andere wegen Rezidivverschluß der Lebervenen nach insuffizienter Marcumareinnahme. Das BCS kann erfolgreich durch eine Lebertransplantation behandelt werden, erfordert jedoch eine lebenslange, engmaschig kontrollierte Anticoagulation zur Rezidivprophylaxe.
    Notes: Summary. Budd-Chiari syndrome (BCS) with hepatic vein occlusion is a rare disorder that can effectively be treated in advanced stages with orthotopic liver transplantation. We report on 16 patients who received 18 liver grafts and were followed up for at least 2 years. In 7 patients a hematological disorder was confirmed by bone marrow biopsy. One patient died after 4 months due to cytomegalovirus pneumonia; another patient died after 2 years due to progressive liver failure after portal vein thrombosis. The actuarial 5-year survival rate is 87.5 % compared to 85.3 % in all other 710 orthotopic liver transplantations performed from September 1988 to December 1995 at our institution. Anticoagulation consisted of intravenous heparin and overlapping continuation with dicoumarin. Three patients received hydroxyurea for thrombocytosis, one patient for 1 week only early after the transplantation. Two postoperative abdominal hemorrhages required laparotomy. Two patients had to be retransplanted, one for thrombosis of the hepatic artery and portal vein after discontinuation of dicoumarin due to GI bleeding and one for hepatic vein thrombosis after insufficient dicoumarin intake. Terminal BCS represents a good indication for orthotopic liver transplantation; however, life-long, closely monitored anticoagulation is essential.
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