Biomedical subjects

Beat Mullhaupt

Publications and source records attributed to Beat Mullhaupt.

4 recordsLinked to original sources

PubMed2003

Living donor liver transplantation and tolerance: a potential strategy in cholangiocarcinoma.

BACKGROUND: Donor-specific immune tolerance has been reported in isolated cases of kidney transplantation associated with bone marrow transplantation. The following is a description of a living donor liver transplantation for a hilar cholangiocarcinoma in a previous recipient of an allogeneic bone marrow transplant. METHOD: A right hemi-liver transplantation was performed using a liver allograft obtained from the same previous bone marrow donor. A neoadjuvant chemo-irradiation protocol was implemented before the procedure. Because of the presence of full chimerism, no immunosuppression has been necessary for the last 22 months. RESULTS: Liver graft function has remained excellent, and a magnetic resonance imaging scan at one and a half years has shown no tumor recurrence. A control liver biopsy at 1 year showed no rejection. CONCLUSIONS: Neoadjuvant chemo-irradiation therapy and removal of all immunosuppression after liver transplantation formed the basic structure of this approach. Additional benefits provided by living donor liver transplantation included limitation of tumor progression by diminishing the pretransplantation waiting time, radical excision of the tumor through a complete hepatectomy, and optimal timing of the transplant procedure within a neoadjuvant chemo-irradiation protocol.

Adult↗

PubMed2003

Successful use of the Molecular Adsorbent Recirculating System (MARS) in a patient with primary biliary cirrhosis (PBC) and treatment refractory pruritus.

Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease often associated with severe pruritus. Despite maximal medical management pruritus often persists and has a detrimental effect on quality of life. For patients that are refractory to all medical treatments, more invasive approaches have been tried. Recently, a new extracorporeal hemodiafiltration method, Molecular Adsorbent Recirculating System (MARS), has been described. Based on the hypothesis that hydrophobic, protein-bound metabolites play a major role in the development of liver failure, this device uses an albumin enriched dialysate to facilitate the removal of albumin bound toxins. AIM: To assess the safety and efficacy of a single MARS treatment on the pruritus score in a patient with PBC and treatment refractory pruritus. DESIGN/PATIENTS: A 61-year-old female patient with biopsy proven PBC, who had been accepted on our liver transplantation waiting list because of treatment refractory pruritus, was subjected to a single MARS treatment. RESULTS: At the end of a single 8 h MARS treatment session pruritus completely disappeared. Not unexpectedly, however, this effect was only short lived. Except for a slight hypercalcemia no adverse events were observed. CONCLUSION: A single MARS treatment very effectively improved pruritus. Long-term repetitive treatment, however, might be necessary to sustain its effectiveness.

Journal Article↗

PubMed2002

Cost-effectiveness of cadaveric and living-donor liver transplantation.

BACKGROUND: Cadaveric liver transplantation (5-year survival >80%) represents the standard of care for end-stage liver disease (ESLD). Because the demand for cadaveric organs exceeds their availability, living-donor liver transplantation has gained increasing acceptance. Our aim was to assess the marginal cost-effectiveness of cadaveric and living-donor orthotopic liver transplantation (OLT) in adults with ESLD. METHODS: Using a Markov model, outcomes and costs of ESLD treated (1) conservatively, (2) with cadaveric OLT alone, and (3) with cadaveric OLT or living-donor OLT were computed. The model was validated with published data. The case-based scenario consisted of data on all 15 ESLD patients currently on our waiting list (3 women, 12 men; median age, 48 years [range, 33-59 years]) and on the outcome of all OLT performed for ESLD at our institution since 1995 (n=51; actuarial 5-year survival 93%). Living-donor OLT was allowed in 15% during the first year of listing; fulminant hepatic failure and hepatocellular carcinoma were excluded. RESULTS: Cadaveric OLT gained on average 6.2 quality-adjusted life-years (QALYs) per patient compared with conservative treatment, living-donor OLT, an additional 1.3 QALYs compared with cadaveric OLT alone. Marginal cost-effectiveness of a program with cadaveric OLT alone and a program with cadaveric and living-donor OLT combined were similar (E 22,451 and E 23,530 per QALY gained). Results were sensitive to recipient age and postoperative survival rate. CONCLUSIONS: Offering living-donor OLT in addition to cadaveric OLT improves survival at costs comparable to accepted therapies in medicine. Cadaveric OLT and living-donor OLT are cost-effective.

Adult↗

PubMed2002

Simulation of hepatitis C based on a mandatory reporting system.

OBJECTIVE: Hepatitis C is a major cause of liver disease in European countries. We aimed to assess the current and future disease burden of hepatitis C. SETTING: A representative data set of hepatitis C was applied to a validated computer model. METHODS: The mandatory reporting of positive hepatitis C virus (HCV) test results by all medical laboratories in Switzerland and the clinical data obtained by questionnaire for each positive test from the treating physicians created a unique, representative epidemiological database allowing the determination of the age distribution of acute (i.e. newly acquired) and chronic HCV infections. Based on these data and a simulation model of the natural history of hepatitis C, we estimated the prevalence of HCV infection, future morbidity/mortality from cirrhosis/hepatocellular carcinoma and costs. RESULTS: Our analysis estimates a prevalence of anti-HCV in Switzerland of 1.25-1.75%, which is slightly higher than prior reports (0.5-1%) derived by extrapolation from selected populations. Although new HCV infections decreased after 1990, our analysis predicts that HCV-related morbidity and mortality will increase by 70-90%, reaching a maximum in 2015-2020, largely from complications in cases already prevalent in 1998. The model predicts that the incidence of cirrhosis will begin to decrease after 2005-2010. Antiviral treatment reduces disease burden by approximately 5%. Undiscounted HCV-related annual direct costs will more than double and reach a maximum of almost US$33 million in 2020. CONCLUSIONS: The incidence of HCV-related cirrhosis is predicted to decrease after 2005-2010, while disease burden and costs due to complications are estimated to continue to increase until 2015-2020.

Adolescent↗