PubMed Health⌕ Search

Biomedical subjects

E L Renner

Publications and source records attributed to E L Renner.

At least 19 recordsLinked to original sources
PubMed2000

[Liver transplantation and tumors: risk and chance].

Liver transplantation is the established therapy of choice for endstages of acute and chronic liver diseases of various aetiologies. The place of liver transplantation in the treatment of malignant liver disease, in particular hepatocellular carcinoma, remains, however, debated: liver transplantation for hepatocellular carcinoma achieves 5-year survival similar to that for other indications, and 5-year disease-free survival better than that following "curative" resection, provided certain criteria are fulfilled (one node max. 5 cm in diameter or max. 3 nodes each of max. 3 cm in diameter). This must be weighed against the uncertainties of preoperative staging and the shortage of donor organs. In contrast, cholangiocarcinoma has a poor prognosis after liver transplantation with 3- and 5-year survival rates below 20%. Only small, incidental, peripheral, intrahepatic cholangiocarcinomas in patients with primary sclerosing cholangitis seem to be an exception to this rule. Liver metastases indicate generalised tumour spread, and thus are not an indication for liver transplantation. Liver transplantation may be justified for liver metastases of neuroendocrine gastrointestinal tumours, provided the primary has been curatively resected and there is no extrahepatic spread. Finally, liver-transplanted (immunosuppressed) patients are at increased risk to develop malignant tumours. This includes in particular epithelial skin tumours, (EBV-associated lymphoproliferative diseases and (HHV8-induced) Kaposi's sarcoma.

Contraindications↗
PubMed2000

[Epidemiology of chronic hepatitis B and C among dialysis patients in Switzerland].

BACKGROUND: Among patients with renal insufficiency undergoing chronic dialysis treatment, chronic hepatitis due to infection with viruses of the hepatitis B (HBV) or hepatitis C (HCV) type represents a serious medical problem. In contrast to other countries, detailed statistics on the prevalence of HBV and HCV infection are not available for dialysed patients in Switzerland. METHODS: The present study is based on a nationwide survey among the Swiss dialysis population which evaluated the prevalence of patients positive for either the HBs antigen (reflecting HBV infection) or anti-HCV antibodies (reflecting HCV infection) in 1999. From our survey we collected data on 1713 haemodialysis and 226 peritoneal dialysis patients, representing 92 and 65% of the respective dialysis populations in Switzerland. RESULTS: Of all patients (haemodialysis and peritoneal dialysis), 6.59% were HBV or HCV marker positive (HBV: 1.44%, HCV: 5.05%). In haemodialysis patients the prevalence was clearly higher for HBV (1.63%) and HCV (5.72%) compared to patients undergoing peritoneal dialysis (0.88 and 3.09% respectively). Laboratory parameters of hepatitis--as evidenced by an increase in liver transaminases--were present in 4% of the entire dialysis cohort, 0.6% having an increase in ALAT beyond 1.5 times the normal range. Patients undergoing treatment in haemodialysis units which do not implement additional precautions to prevent the spread of HCV among patients were more likely to be HCV marker positive with laboratory signs of hepatitis. A similar correlation was observed between HBV or HCV marker positivity and the number of patients treated per haemodialysis unit. Finally, the percentage of HBV/HCV marker positive patients on the Swiss kidney transplant list is comparable with that of HBV/HCV marker positive patients in the entire dialysis population.

Hepatitis B Surface Antigens↗
PubMed1999

[Therapy of chronic hepatitis B and C].

10% of patients infected with the hepatitis B virus develop a chronic hepatitis. The only approved therapy is interferon-alpha, which leads in 30-40% to a HbeAg/anti-Hbe Seroconversion. In contrast, the infection with the hepatitis C virus leads to a chronic hepatitis in over 80%. Here again interferon-alpha is the only approved drug to treat these patients. A sustained normalisation of transaminases and a sustained virological response can be achieved in 20 to 40% at most. In view of these unsatisfactory treatment results, new treatment options are currently being evaluated for both infections. Treatment with nucleoside analogues are being tested in patients with chronic hepatitis B and for the treatment of chronic hepatitis C a combination treatment seems most promising.

Antiviral Agents↗
PubMed1999

Early acute cellular rejection: no effect on late hepatic allograft function in man.

Whereas early acute cellular rejection, even if successfully treated, seems to have an impact on late function and survival of kidney and heart transplants, little quantitative data are available on its effect(s) on liver transplants. Routine liver function tests, the functioning liver cell mass (galactose elimination capacity) and microsomal metabolic capacity (aminopyrine breath test) were determined prospectively in 37 consecutive patients 1 year after liver transplantation. Of these, 19 (7 females and 12 males, 32-69 years of age) had previously required treatment for at least one biopsy proven acute cellular rejection episode occuring a median 7 days after grafting, while 18 (6 females and 12 males, 30-67 years of age) had not. The functioning liver cell mass and microsomal metabolic capacity were both within normal limits for the majority of patients and did not differ significantly between patients with and without previous acute cellular rejection episodes. In contrast to other solid organ transplants, early acute cellular rejection episodes do not affect late function of liver allografts in man.

Acute Disease↗
PubMed1999

Primary liver disease as a determinant for acute rejection after liver transplantation.

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 posttransplant 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.

Acute Disease↗
PubMed1998

[Drug therapy of chronic hepatitis B].

Medical therapy of chronic hepatitis B aims at halting progression towards cirrhosis/hepatocellular carcinoma by inhibiting replication of hepatitis B virus in a sustained fashion (viral elimination). The sole therapy of proven efficacy is interferon-alpha (5-10 Mio IU sc TIW) which leads within 4 months to viral elimination (seroconversion from HBeAg to anti-HBe-antibody; serum HBV-DNA negative by hybridisation) in approximatively 40% of patients. Interferon-alpha therapy has been shown to decrease hepatitis B associated morbidity/mortality and to be cost-effective. Certain nucleoside analoga such as lamivudine or famciclovir are able to stop hepatitis B virus replication in a large proportion of patients; replication promptly resumes however after cessation of treatment and resistance develops in approximatively 15% of patients treated for one year. The clinical value, in particular for interferon-alpha non-responders, of a combination of interferon-alpha and/or nucleoside analoga remains to be seen.

2-Aminopurine↗
PubMed1998

Hepatocellular defence against acidosis is preserved after cold storage.

BACKGROUND: Primary non-function of liver allografts is related to preservation time, during which hypoxia leads to intracellular accumulation of acid. Preservation-induced failure of hepatocellular pH regulation may play a role in the pathogenesis of primary graft non-function. METHODS: Using cultured/suspended rat hepatocytes and fluorimetric determination of intracellular pH, we determined whether preservation in University of Wisconsin solution (4 degrees C) impairs hepatocellular defence mechanisms against acidosis. RESULTS: In non-preserved, 24-h-preserved and 48-h-preserved hepatocytes acidified to pH 6.7-6.8, initial Na+/H+ antiport-mediated H+ fluxes averaged 12 +/- 5, 9 +/- 5 and 12 +/- 5 nmol microL-1 min-1 and initial Na+/HCO3- symport-mediated HCO3- fluxes 7 +/- 2, 7 +/- 3 and 6 +/- 2 nmol microL-1 min respectively (P = NS). Preservation did not affect the inverse relationship between Na+/H+ antiport activity and intracellular pH. Thus, hepatocellular defence against intracellular acidosis is maintained during up to 48 h in University of Wisconsin solution. CONCLUSION: Altered pHi homeostasis is unlikely to play a role in the pathogenesis of primary non-function of liver allografts.

Acidosis↗
PubMed1998

[Management of the liver transplant patient].

The general practitioner plays a crucial role in the care for the liver transplant recipient. The number of liver transplant recipients increasing steadily by about 50 a year in Switzerland, the practitioner will increasingly be confronted with such patients. A close cooperation between general practitioner and transplant center is mandatory and the key to success. This paper aims at introducing the general practitioner to the care for the liver transplant recipient.

Humans↗
PubMed1997

[Liver transplantation in a small center: feasibility, efficacy and prospects].

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.

Academic Medical Centers↗
PubMed1997

[Liver transplantation at the Bern Island Hospital: results from the last 5 years].

Today, orthotopic liver transplantation (OLT) is the treatment of choice for the endstage of various liver diseases, a 1-year survival rate of 80% and a 5-year survival rate of 70% in elective patients without tumor is reported in international surveys. The liver transplant program of the Inselspital Bern is very small compared with international centers, and this may raise questions about the (long-term) results and the justification for such a program. During the last 63 months, 59 liver transplantations (including two retransplants) have been performed in 57 patients at the Inselspital. The 30-day mortality was 3.5% and the 2.5-year overall survival rate was 82% and 93% for elective cases without tumor. After a median follow-up of 29 months, 67% of all patients were reintegrated fully or part-time in their profession and 81% were independent of others' help. We conclude that even a small liver transplant program based on routine resources only can achieve results which are comparable to international standards.

Adult↗
PubMed1997

[Esophageal varices].

Variceal hemorrhage still carries a high mortality and a high risk of recurrence. Esophageal varices bleed rarely with a porto-systemic pressure gradient below 12 mmHg; pharmacotherapy, thus, aims at lowering the pressure gradient below this critical threshold. Conceptually, this can be achieved by decreasing portal-venous inflow (via lowering cardiac output and/or increasing splanchnic-arteriolar vasoconstriction) or by decreasing portal-venous resistence (via portal vasodilation). In acute variceal bleeding, easily applicable pharmacotherapy with terlipressin plus nitroglycerin, probably also with octreotide, can help to stabilize the patient and to buy time until diagnostic endoscopy and treatment by sclerotherapy or variceal band ligation. For pharmacotherapeutic secondary prophylaxes of variceal hemorrhage the combination of propranolol or nadolol with isosorbid-5-mononitrate is available. Future studies will tell, whether this drug combination is superior to the nowadays established endoscopic eradication of varices, especially by long-term variceal band ligation. For primary prophylaxis of variceal hemorrhage non-selective beta-anatagonists remain the therapy of choice in compliant patients with esophageal varices and endoscopic signs indicating a high risk of bleeding. Future studies must clarify the role of the beta-antagonist-nitrate combination, as well as that of prophylactic variceal band ligation, in this setting.

Adrenergic beta-Antagonists↗
PubMed1996

Fixed versus titrated interferon-alpha 2B in chronic hepatitis C. A randomized controlled multicenter trial. The Swiss Association for the Study of the Liver.

BACKGROUND/AIM: Interferon has become the mainstay of treatment of chronic hepatitis C; however, duration of treatment and dose remain unresolved questions. The present study aimed to compare standard dose interferon with a titrated dose regimen carried out for 1 year. METHODS: This was a randomized, controlled multicenter trial. Patients with chronic hepatitis C were randomly allocated to a control group (n = 30), to a fixed dose group (n = 31) where interferon-alpha 2b 3 MU thrice weekly was given for 1 year or a titrated group (n = 34) where interferon was titrated starting at 5 MU thrice weekly to the lowest dose keeping the patient in remission as assessed by a normal ALT value. Liver biopsies were obtained before and at the end of treatment; in addition, galactose elimination capacity was measured as a measure of cytosolic function. RESULTS: In the control, fixed and titrated groups a complete response was achieved in 2/29, 10/28 and 15/31, respectively (p < 0.001 in favor of treatment, p = n.s. for the two treatments). The corresponding figure for sustained response was 1/29, 5/28 and 6/ 31 (p = n.s). In the titrated group, a complete (sustained) response was achieved with 5 MU in 2 (2), with 4 MU in 1 (0), with 3 MU in 4 (0), with 2 MU in 3 (0) and with 1 MU in 5 (4). Liver biopsy score and galactose elimination capacity improved significantly in responders but not in treatment failures. CONCLUSIONS: Both fixed and titrated dosing of interferon given for 1 year induced virus clearance in only a minority of treated patients. However, in a small number of patients, a complete and sustained response can be achieved with low doses of interferon. Dose titration could be an interesting approach to decreasing the cost and side effects in the treatment of chronic hepatitis C.

Adult↗
PubMed1996

Differential expression of Na+,H(+)-antiporter mRNA in biliary epithelial cells and in hepatocytes.

BACKGROUND/AIMS: Amiloride inhibitable Na+,H(+)-exchange has recently been identified and characterized in rat biliary epithelial cells where its activity at low intracellular pH is significantly higher than in hepatocytes. METHODS: Northern blot and reverse transcription-polymerase chain reaction were used to study the expression of the different Na+,H(+)-antiporter isoforms in isolated biliary epithelial cells and hepatocytes. RESULTS: The present study demonstrates for the first time the expression of Na+,H(+)-antiporter isoform 1 mRNA in rat biliary epithelial cells. Moreover, steady-state levels of this message were several-fold higher in biliary epithelial cells than in hepatocytes. In addition, the expression of Na+,H(+)-antiporter isoform 2 in bile duct epithelial cell but not hepatocytes could be demonstrated by reverse transcription-polymerase chain reaction. CONCLUSIONS: The higher expression of Na+,H(+)-antiporter isoform 1 mRNA may indicate a higher rate of synthesis and therefore a higher Na+,H(+)-exchange activity in biliary epithelial cells than in hepatocytes and is entirely compatible with the results of the previous functional studies.

Animals↗