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G Gubernatis

Publications and source records attributed to G Gubernatis.

At least 37 records · Page 2Linked to original sources
PubMed1994

Auxiliary partial orthotopic liver transplantation for acute liver failure: the Hannover experience.

APOLT has been developed both to enable the native liver to regenerate in acute liver failure and to avoid the risks of long-term immunosuppressive therapy. We present our experience with APOLT in 4 patients with acute liver failure. The patients were 33, 18, 5, and 34 years of age, respectively. The causes of hepatic failure were: one HELLP syndrome, one paracetamol intoxication, and 2 causes which remained undetermined. All patients were in coma before transplantation. First symptoms had occurred 13, 2, 30, and 20 days prior to APOLT, respectively. In all cases, segments II and III of the recipient's own liver were resected before implanting the auxiliary liver orthotopically. The auxiliary graft consisted of segments II and III in 2 cases and of II, III, and IV in the other 2 patients. The auxiliary graft showed good initial function in all cases. All 4 patients are alive 5 years, 15 months, 6 months, and one month after transplantation. In the last patient, an arterial thrombosis of the graft on the 5th postoperative day required retransplantation. The immunosuppressive therapy could be stopped in 3 cases and the graft was removed in 2 patients 15 and 40 days after APOLT, respectively. This shows that APOLT represents an effective treatment for patients with acute liver failure, which enables restoration of native liver function. Thus, APOLT should be considered in every patient with acute and potentially reversible liver failure in whom a transplantation is indicated.

Acetaminophen↗
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

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

Changes in energy substrates in relation to arterial ketone body ratio after human orthotopic liver transplantation.

BACKGROUND: Changes in energy substrate metabolism, as well as those in arterial ketone body ratio (KBR; acetoacetate/3-hydroxybutyrate), were investigated to follow energy status of hepatic allograft. METHODS: Plasma concentrations of energy substrates were measured immediately after 35 orthotopic liver transplantations in 32 adult patients. RESULTS: Twenty-three patients left the intensive care unit within 1 month (group A), six patients were forced to stay in the intensive care unit longer than 1 month (group B), and the other six grafts failed within 1 month (group C). In group B the KBR was significantly lower than in group A 6 hours after reperfusion of the grafts (0.70 +/- 0.09 vs 1.21 +/- 0.10, mean +/- SEM; p < 0.05). In group C the KBR remained significantly lower than in group A at 6 hours (0.65 +/- 0.04 vs 1.21 +/- 0.10; p < 0.01), on the first postoperative day (0.64 +/- 0.03 vs 1.36 +/- 0.10; p < 0.001), and on the second postoperative day (0.65 +/- 0.02 vs 1.58 +/- 0.11; p < 0.01). Total ketone body concentration (TKB) was significantly higher in group B than in group A at 4 hours (462.9 +/- 105.0 mumol/L vs 201.6 +/- 32.6 mumol/L; p < 0.01), 6 hours (483.4 +/- 102.1 mumol/L vs 125.5 +/- 25.9 mumol/L; p < 0.001), and the first postoperative day (481.1 +/- 196.6 mumol/L vs 123.9 +/- 24.1 mumol/L; p < 0.001). No increase in TKB was observed in group C. CONCLUSIONS: It is suggested that low values in KBR accompanied with low levels of TKB should be regarded as a strong indicator of graft failure and fatty acid oxidation and ketogenic pathways are accelerated to compensate for energy deficits in patients with low values in KBR and high levels of TKB until KBR recovers immediately after orthotopic liver transplantation.

Acyl Coenzyme A↗
PubMed1992

Receiver operating characteristic (ROC) analysis of the ability of arterial ketone body ratio to predict graft outcome after liver transplantation--its sensitivity and specificity.

To evaluate the ability of arterial ketone body ratio (AKBR; acetoacetate/3-hydroxybutyrate) to predict graft prognosis after liver transplantation, the diagnostic value as a predictive index was compared between AKBR and conventional liver function tests using receiver operating characteristic (ROC) analysis. The ROC curves were determined for AKBR, GOT, GPT, total bilirubin, serum lactate level, and prothrombin time, all of which were measured on the 1st and 2nd postoperative days in 88 cases of liver transplantation. Comparisons of the areas under the ROC curves between AKBR and other tests revealed the significant superiority of AKBR to other tests in predicting graft death within 1 month after transplantation. The present study suggests that AKBR can be used as an accurate index to predict graft prognosis after liver transplantation.

Adolescent↗
PubMed1991

[In situ protection of the liver with Bretschneider HTK solution].

Liver resections are usually performed under occlusion of the hepatoduodenal ligament (Pringle manoeuvre) in order to limit operative blood loss. The maximal ischemic tolerance, although individually different, is generally accepted to be 60 min. Resections of centrally located tumors require precise preparation, sometimes combined with vascular reconstructions. In such cases a prolonged ischemic time is inevitable. A save prolongation of the ischemic tolerance could be useful for extensive liver resections. In an experimental study in pigs ischemic tolerance of the liver was studied under hypothermic protection with the HTK solution of Bretschneider during 2 and 3 h. Deterioration of liver function was compared with a warm ischemia during 2 h. Results showed significantly less serum transaminase activities and better hepatic blood flow (ICG test) after an ischemia under protection with the HTK solution compared to a warm ischemia during 2 h. A prolonged ischemia during 3 h under protection with the HTK solution was well tolerated. First clinical applications of hypothermic hepatic protection during resection were successful.

Animals↗
PubMed1991

Liver transplantation in HBs antigen (HBsAg) carriers. Prevention of hepatitis B virus (HBV) recurrence by passive immunization.

Liver transplantation in HBs-antigen (HBsAg) positive allograft recipients is associated with a high risk of HBV recurrence some time after surgery. So far, results of measures to prevent recurrent HBV-infection by means of treatment with interferon, hepatitis B vaccination and short-term passive immunization with hepatitis B immunoglobulin (HBIg) or monoclonal antibody to HBsAg (anti-HBs) have been disappointing. In the present study the results of long-term, anti-HBs monitored passive immunization with HBIg is reported. In 23 HBsAg-positive liver transplant recipients an anti-HBs level of greater than or equal to 100 IU/l was maintained for 6 or 12 months, respectively. The rate of recurrent infection was found to be less than 20% under HBIg substitution, whereas 11 graft recipients with no or only short-term HBIg prophylaxis were reinfected by month 15 after transplantation. HBV recurrence was associated with chronic liver disease and recurrent cirrhosis in the allograft.

Adolescent↗
PubMed1991

Management of severe hepatic trauma by two-stage total hepatectomy and subsequent liver transplantation.

Even today major hepatic trauma remains a formidable surgical challenge with considerable deaths from exsanguination. Apart from conservative operative techniques that allow successful management in most cases, liver transplantation may be indicated in a more severe injury. This is a report on a patient with massive, unsalvageable liver trauma on whom the first two-staged procedure was successfully performed. After total hepatectomy as the first step and a prolonged anhepatic period of more than 14 hours, liver replacement by an allograft was carried out in a second operation. The patient recovered completely from the potentially lethal hepatic trauma and is alive more than 17 months later.

Accidents, Traffic↗
PubMed1990

Technique and preliminary results of extracorporeal liver surgery (bench procedure) and of surgery on the in situ perfused liver.

The clinical experience with 11 patients undergoing ex situ operation of the liver (nine operations) or surgery on an in situ hypothermic perfused liver after vascular isolation (three operations) is described. These methods have been confined to situations and tumour stages otherwise deemed untreatable, or to situations where resection would not have been sufficiently radical. In one patient the ex situ approach avoided the need to undertake liver grafting for a benign tumour. To date, hepatocellular tumours and metastases not compromising global hepatic function or causing cholestasis are considered to be suitable conditions; cholestasis appears to be highly detrimental for the postoperative course after an ex situ procedure. Elaboration of methods for better grading of pre-existing liver damage and of its prognostic significance is essential. The assessment of the final therapeutic value of the described procedure requires further experience.

Adult↗