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Biomedical subjects

B Ringe

Publications and source records attributed to B Ringe.

At least 145 records · Page 8Linked to original sources
PubMed1993

Conversion from cyclosporin to FK 506 after liver transplantation.

Thirty-seven liver-grafted patients with steroid-resistant acute or chronic graft rejection or with cyclosporin-related complications were converted from CyA to FK 506. The clinical outcome of the patients primarily depended on the degree of liver dysfunction present at initiation of FK 506 treatment. In patients switched to FK 506 for treatment of acute or early chronic graft rejection, CyA nephrotoxicity, or CyA malabsorption, the FK 506 therapy was associated with a clear improvement in the clinical course. In contrast, in patients with advanced chronic graft rejection, a lower response rate to the conversion in immunosuppression was observed. The lower response rate was associated with a higher patient mortality. These studies demonstrate that FK 506 represents a valuable alternative immunosuppressant for liver-grafted patients. The conversion from CyA to FK 506 should take place before serious--and potentially irreversible--disturbances in liver function are observed.

Acute Disease↗
PubMed1993

Serum bile acids and esterified bilirubin in early detection and differential diagnosis of hepatic dysfunction following orthotopic liver transplantation.

Routine laboratory tests are of little help for early detection and differential diagnosis of hepatic dysfunction following orthotopic liver transplantation (OLT). In the present study, serum levels of esterified bilirubin, total bilirubin and bile acids were investigated in 20 patients after OLT. Twenty episodes of liver dysfunction were observed: 10 rejection episodes, 3 cases of thrombosis of the hepatic artery, 3 cases of septic shock, and 4 episodes of cyclosporin toxicity. During rejection, the median increase in esterified bilirubin was 3.2-fold (range 1.6-24.9), while total bilirubin increased 1.5-fold (range 0.7-3.4). Bile acids increased 3.6-fold (range 2.5-6.6; peak levels 25-87 microM). Both bile acids and esterified bilirubin increased 1-3 days earlier than serum transaminases and decreased only after successful anti-rejection treatment. The response of bile acids to successful treatment was usually more rapid than the response of esterified bilirubin. Hepatic artery thrombosis and septic shock were associated with a sharp increase in esterified bilirubin and very high bile acid levels (peak levels 80-185 microM). During cyclosporin toxicity, a characteristic pattern of progressively increasing bilirubin with no change in the bile acid levels was observed. Both esterified bilirubin and bile acids are very sensitive indicators of hepatic graft dysfunction. In particular, serum bile acids are useful for identifying cyclosporin toxicity and monitoring the response to anti-rejection treatment.

Bile Acids and Salts↗
PubMed1993

Total hepatectomy and liver transplantation as two-stage procedure.

OBJECTIVE: This article describes the experience with a bridging procedure for a prolonged anhepatic period during clinical liver transplantation in case of special emergency situations. SUMMARY BACKGROUND DATA: Hepatic necrosis due to fulminant hepatitis or acute graft failure, as well as severe liver trauma are well-known and accepted indications for urgent liver transplantation. Prerequisite is the allocation of a suitable donor organ. If no allograft is available in time, patients with "toxic liver syndrome" or exsanguinating hemorrhage have been shown to benefit from advanced total hepatectomy. METHODS: As a modification of the standard one-stage procedure, recipient hepatectomy and subsequent liver transplantation are performed in two separate operations. To bridge the prolonged anhepatic period and to allow decompression and return of venous blood, an end-to-side portocaval shunt is constructed temporarily. RESULTS: Thirteen of thirty-two patients underwent hepatectomy but not transplantation subsequently, and died within 34 hours after progressive deterioration. In 19 of 32 patients, transplantation was realized 6-41 hours after hepatectomy; 9 of 19 patients died, mostly from sepsis. Ten of nineteen liver recipients survived the procedure including three unrelated late deaths; presently, seven patients are alive with a follow-up of 3 to 46 months. CONCLUSIONS: Two-stage total hepatectomy with temporary portocaval shunt, and subsequent liver transplantation can be a life-saving approach in patients most likely to die of the sequelae of advanced liver or graft necrosis or exsanguination that cannot be controlled by conventional treatment or immediate liver transplantation.

Adolescent↗
PubMed1993

Arterial ketone body ratio as a predictor of donor liver viability in human liver transplantation.

The viability of the donor liver was assessed with regard to early postoperative survival in human liver transplantations from 40 brain-dead donors at Hannover Medical College and 13 living donors at Kyoto University by measuring the arterial ketone body ratio (AKBR). Of 40 grafts harvested from brain-dead patients in Hannover, 35 survived the first week after operation, but 5 developed initial nonfunction of the transplanted graft within the first week. The mean AKBR values were 1.11 +/- 0.11 for grafts that survived and 0.44 +/- 0.10 for grafts that failed (P < 0.01). The AKBR values of the 5 initially nonfunctioning cases were all below 0.7. Of 13 grafts harvested from the living donors in Kyoto, all survived the first week. The AKBR values of the donors were all above 1.0, with a mean value of 1.87 +/- 0.23. Among all 53 cases, the survival rate of the grafts with AKBR above 0.7 was significantly higher than that of the grafts with AKBR below 0.7 (100% vs. 62%, P < 0.01). No other donor parameters, including age, dose of dopamine administered, and clinical laboratory findings, were significantly related to differences in graft survival rates. AKBR is a useful index for the evaluation of donor liver viability. Grafts used from donors with AKBR of less than 0.7 have a significantly increased risk of early nonfunction. Grafts from donors with AKBR of greater than 1.0 have, in our experience, always been viable after transplantation.

Adult↗
PubMed1993

Persistence of donor lymphocytes in liver allograft recipients.

Occasional cases of graft-versus-host disease after liver transplantation indicate a transfer of donor lymphocytes by human liver grafts. However, little is known about the usual fate and potential function of passenger lymphocytes in clinical liver transplantation. In this study, we have analyzed liver graft recipients for the presence of donor lymphocytes in the early course after transplantation. The presence of such cells in blood, the graft, and, occasionally, the skin was studied by the use of mAb to polymorphic HLA class I determinants and double-staining techniques in flow cytometry and immunocytology. The findings were compared with the clinical courses and with the results of routine graft biopsies. Within the first week after transplantation, in all 16 patients, between 1% and 24% donor lymphocytes (T, NK, and B cells) were detectable in blood, and in 14 of 22 patients (64%), between 2% and 23% donor T cells were found in the graft. After more than 2 weeks, donor cells were still present in blood in 2 of 14 patients at very low numbers. The presence of donor lymphocytes in the graft was associated with intragraft immune activation in 5 of 15 patients, but no clinical rejection occurred in these cases; mild graft-versus-host disease was observed in one patient. These findings demonstrate that donor lymphocytes regularly persist in liver-grafted patients for some time; this transient mixed lymphoid chimerism is only rarely associated with clinical graft-versus-host disease and some evidence even suggests that these donor-derived lymphocytes may exert beneficial immunomodulatory properties.

Adult↗
PubMed1993

Diagnostic value of color Doppler sonography in primary liver tumors--a trend study.

In order to investigate the diagnostic value in differential diagnosis of primary liver tumors, color Doppler sonography was used preoperatively in 30 patients. Without difference, tumor hypervascularization was found in patients with hepatocellular carcinoma (2 of 4), cholangiocellular carcinoma (4 of 4), hemangioma (3 of 8), focal nodular hyperplasia (8 of 8), adenoma (3 of 4), and neuroendocrine tumor (n = 1). No vascular signal could be detected in 1 case of adenomatous hyperplasia and 2 cases of hepatocellular carcinoma, one after previous chemoembolization. Hemangioma appeared hypo- or even avascular in 5 of 8 patients. Therefore, according to our experience, the yield of color Doppler sonography is rather low for differential diagnosis and prediction of the tumor dignity. With regard to the surgical procedure, valuable information about tumor extension can be obtained particularly in central lesions close to hilar structures or liver vein confluence. Further indications result from follow-up of tumor vascularization after chemoembolization and chemotherapy.

Adenoma, Liver Cell↗
PubMed1993

Cystic enlargement of extrahepatic bile ducts.

BACKGROUND: Cystic enlargement of the extrahepatic bile duct system is a rare abnormal finding. A congenital origin is usually supposed; however, the pathogenesis is unknown. We report on our experience with extrahepatic bile duct cysts with special regard to cause, treatment, and recurrent disease. METHODS: From 1976 to 1991, 13 patients, 35 to 74 years of age, were treated for extrahepatic bile duct cysts. Seven patients had previously undergone cholecystectomy. Two patients were admitted because of recurrent disease; neither had undergone curative resection. RESULTS: In 11 patients a biliojejunal anastomosis with a Roux-en-Y was created after cyst resection; one patient underwent a diverticular stalk resection with end-to-end anastomosis of the choledochal duct. After a mean follow-up of 68 months eight of 10 patients were alive, two of whom complained about cholangitis. Recurrent diffuse dilatation of the remaining choledochus developed in one patient; one other patient died of cholangiocellular carcinoma 2 years after operation. CONCLUSIONS: In patients who had undergone previous cholecystectomy or with recurrent disease an acquired malformation cannot be excluded. Surgical treatment is always indicated because of imminent complications and should aim at complete resection of cystic tissue. Periodic postoperative evaluation is necessary to detect recurrent disease and malignant transformation.

Adult↗