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Biomedical subjects

G Blumhardt

Publications and source records attributed to G Blumhardt.

At least 91 records · Page 5Linked to original sources
PubMed1992

[Orthotopic liver transplantation in hepatic cirrhosis: on the problem of infection of the transplant with persistent hepatitis viruses].

269 orthotopic liver transplantations (OLT) were performed in 253 patients at our institution from September 1988 to May 1992. 121 patients had end-stage cirrhosis secondary to viral hepatitis type B, delta, or type non-A non-B and C respectively. Reinfection of the graft by persistent viruses is a potential complication in these cases. Passive immunization with anti-HBs hyperimmunoglobulin (HIg) can prevent clinically relevant reinfection of the graft in patients with hepatitis B virus (HBV) infection and low replication rates. Patients with high replication rates will rarely benefit from OLT. Patients with hepatitis delta virus (HDV) infection usually experience HDV reinfection of the graft with subsequent chronic hepatitis although prophylaxis with anti-HBs-HIg was performed. Treatment with interferon alpha had no apparent effect on the incidence of graft reinfection with HBV in this series, but the replication rate of HDV was reduced. Persistent hepatitis C viruses (HCV) usually infect the graft; this was demonstrated in 17 patients by means of the polymerase chain reaction. HCV infection usually causes a mild form of acute hepatitis with transition to a chronic course. Therefore the significance of persistent viral infection lies in the potential for chronic hepatitis in the transplanted organ rather than in the danger of acute injury of the allograft.

Biopsy, Needle↗
PubMed1992

[Progress in the field of liver transplantation in the last 10 years].

During the past 10 years, liver transplantation has developed into an established form of treatment. In 1991 alone, almost 450 liver transplants were performed in Germany with a mean 1-year survival of 70%. Consistent progress in the fields of organ preservation, surgical techniques, and prevention of disease recurrence has made a more than 90% 1-year survival rate achievable during the last 3 years in Berlin. Progress in organ preservation is based on the use of colloidal solutions, pharmacological improvement of microcirculation, and probably prevention of reperfusion injury by the use of calcium antagonists and free oxygen radical scavengers. Improvements in surgical techniques have led to a reduction in blood loss and vascular complications, and to a drastic reduction of biliary leaks and stenosis. The introduction of cyclosporin, FK-506, and monoclonal antibodies into immunosuppressive therapy has contributed to the improvement of results in a major way. Furthermore, progress in intensive care in the areas of fluid therapy and blood component substitution, respiratory care and prophylaxis of infection as well as postoperative nutrition has led to a reduction in early postoperative morbidity and mortality. Efficient prophylaxis of the recurrence of hepatitis-B-virus-related disease by using hepatitis B hyperimmunoglobulin after liver transplantation has prevented this lethal recurrence, which was previously frequent, in a large group of patients.

Critical Care↗
PubMed1991

Does antioxidant treatment have a role in liver transplantation?

Liver transplantation has evolved into a relatively safe clinical procedure for end stage liver disease but the success is absolutely dependent on the quality of the donor organs. Graft malfunction is an important source of morbidity and mortality after liver transplantation so further improvement of organ quality is mandatory. Experimental data seem to justify application of antioxidant therapy in clinical liver transplantation. According to the mode of action antioxidant therapy treatment should be considered for donor and recipient of the graft.

Antioxidants↗
PubMed1991

Follow-up of recurrent hepatitis B and delta infection in liver allograft recipients after treatment with recombinant interferon-alpha.

Reinfection of the graft with hepatitis B virus (HBV) and hepatitis delta virus (HDV) is a potential complication in patients undergoing orthotopic liver transplantation (OLT). Therefore, we added recombinant interferon-alpha (rIFNa) to the standard immunosuppressive regimen in 11 patients who received transplants following liver failure attributed to cirrhosis B (n = 10, with HDV co-infection in four cases) or fulminant hepatitis B (n = 1). Patients were treated with rIFNa for periods ranging from 2 to 3 months between the first and the 13th month after OLT. All patients received immunosuppressive treatment with low-dose corticosteroids, azathioprine and cyclosporine. Anti-HBs hyperimmune globulin was also administered. None of the patients showed evidence of severe allograft rejection. Seven patients suffered HBV reinfection of the graft with histological signs of acute hepatitis in five cases and transition to chronic hepatitis in one patient. Treatment with rIFNa did not prevent or reduce HBV replication. Reinfection of the graft with HDV was demonstrated by PCR in four patients co-infected with HDV. During treatment with rIFNa liver biopsy specimens from three reinfected patients were transiently negative for HDV antigen but not for HDV RNA, and the sera from two patients were transiently negative for HDV RNA. The data indicate that rIFNa can reduce HDV replication in reinfected liver allografts.

Adrenal Cortex Hormones↗
PubMed1991

Possible role of extracellularly released phagocyte proteinases in coagulation disorder during liver transplantation.

Orthotopic liver transplantation is frequently associated with a complex coagulation disorder, influencing the outcome of the procedure. In this respect, disseminated intravascular coagulation (DIC) had been suggested to be of causative importance for bleeding complications after reperfusion of the liver graft. In 10 consecutive patients undergoing orthotopic liver transplantations, we studied the occurrence of two phagocyte proteinases of different origin in the graft liver perfusate and in systemic blood during the operation, as well as their effects on hemostasis. As compared with plasma samples taken at the end of the anhepatic phase, highly significant increases of cathepsin B and thrombin-anti-thrombin III complexes (TAT), as well as highly significant decreases in antithrombin III, protein C, and C1-inhibitor were observed in graft liver perfusate. Von Willebrand factor and fibrinogen were slightly decreased, whereas the elastase-alpha 1 proteinase inhibitor complexes (EPI) were elevated. In plasma the activity of cathepsin B remained unchanged during the prereperfusion phases, but immediately after revascularization of the graft this cysteine proteinase increased. The EPI showed a gradual increase in plasma during the preanhepatic and anhepatic phases but a more pronounced increase in the reperfusion phase. In parallel with the rise in these two proteinases TAT increased and the activities of antithrombin III and C1-inhibitor in plasma decreased after reperfusion. At 12 hr after revascularization plasma levels of TAT, antithrombin III, and C1-inhibitor had returned to the prereperfusion ranges, whereas cathepsin B and EPI were significantly above the baseline levels. These observations are consistent with the hypothesis that extracellularly released lysosomal proteinases may play a role in the development of a DIC-like constellation, including thrombin formation after revascularization of the liver graft. For the first time we could prove the occurrence of phagocyte proteinases in graft liver perfusate and evaluate the importance of these proteinases for the understanding of the pathophysiology leading to bleeding complications in patients undergoing orthotopic liver transplantation.

Antithrombin III↗
PubMed1991

Surgery for portal hypertension.

Now that endoscopic sclerotherapy is available, the rôle of surgery in portal hypertension needs to be reconsidered. Emergency treatment of bleeding esophageal varices is based on sclerotherapy, which has widely replaced such surgical procedures as emergency portocaval shunts. Sclerotherapy can be extended to repeated endoscopic sclerosis as definitive management to prevent recurrence of variceal bleeding. Only if varices cannot be treated adequately by sclerotherapy, or in the case of local complications are surgical measures of decompression indicated. For "Child C" patients gastric devascularization or transsection should be considered. For "Child A" or "Child B" patients, distal splenorenal shunts or portocaval shunts should be given preference.

Emergencies↗
PubMed1990

Management of portal venous thrombosis in hepatic transplant recipients.

Portal venous thrombosis in hepatic transplant candidates is considered a relative contraindication to transplantation. In addition to thrombectomy, which is often technically impossible, donor portal venous arterialization or extra-anatomic venous bypass have been described. Two patients who underwent portal venous resection and subsequent anatomic reconstruction are presented herein. In the first patient, a graft with donor common iliac vein was interposed, and in the second, the donor portal vein was long enough to be anastomosed to the mesentericosplenic venous confluens. One patient is well 12 months after transplantation with patent portal vein and the other died of fungal sepsis after rejection treatment (the portal vein being open and unobstructed at autopsy).

Anastomosis, Surgical↗