BACKGROUND/AIMS: [corrected] Hepatobiliary carcinoma (HBC) has been considered to be a late complication of end-stage primary sclerosing cholangitis (PSC). The incidence of HBC is approximately 20% in PSC patients evaluated for liver transplantation. The diagnosis of HBC is difficult, at least at an early stage and the prognosis is poor even after liver transplantation. The aim of the study was to look for signs and risk factors for developing hepatobiliary carcinoma in patients with PSC. METHODS: Thirty-six consecutive patients with PSC and HBC (32 with bile duct carcinoma, BDC, and four with hepatocellular carcinoma, HCC) were pair-matched to control patients referred for liver transplantation because of PSC but who did not have HBC. Gender and age at referral were used as matching factors. Clinical and biochemical data were registered. RESULTS: PSC patients with BDC had a shorter median duration of PSC (1 year) compared with the controls (7 years) and PSC patients with HCC (8 years). There were no statistically significant differences in the liver biochemistry between the patient groups. Varices were more common in patients with PSC and HCC (100%) than in controls (56%) or patients with PSC and HBC (12%) (P < 0.0005). CONCLUSIONS: The relatively short duration of PSC and the absence of varices in patients with BDC suggest that BDC, unlike HCC, is not necessarily a late complication of end-stage PSC, as was previously assumed.

Adolescent↗

PubMed2001

Characterization of Forssman and other antigen/antibody systems in vascularized mouse heart to rat xenotransplantation.

In the present study, the nature of hyperacute xenograft rejection was closely studied in a vascularized mouse-to-rat transplantation model. Antibodies against mouse heart, erythrocytes and lymphocytes and against the Forssman antigen were raised in the rat. Upon heterotopic heart transplantation the respective antisera were intravenously (i.v.) injected. Passive transfer of antiheart, antierythrocyte or antilymphocyte serum resulted in hyperacute rejection of the transplanted mouse heart. Subfractionation of the antiheart serum showed that the capacity to induce hyperacute rejection was carried by the immunoglobulin (Ig)G fraction. When antierythrocyte serum adsorbed with mouse erythrocytes was administered the cardiac grafts remained beating. To the contrary, antilymphocyte serum adsorbed with erythrocytes still had the capacity to induce hyperacute rejection. None of the rats that had previously been challenged with the Forssman antigen rejected their grafts hyperacutely. Subsequent investigations by electron microscopy revealed that the Forssman antigen is expressed on dendritic cells (DC) adjacent to the vessels, but not on the vascular endothelium, thus explaining the inability of the anti-Forssman serum to induce hyperacute rejection. Taken together, we have demonstrated the existence of several xenoantigens that can be targets for antibody-mediated rejection, suggesting that more than one relevant xenoantigen exists also in more distantly related combinations, such as the pig-to-human combination.

Acute Disease↗

PubMed2001

Decreasing ratios of phosphocreatine to beta-ATP correlates to progressive acute rejection in a concordant mouse heart to rat xenotransplantation model.

Biopsies are difficult to perform in rodent heart transplant models without compromising the graft function and therefore other means to evaluate the grafts repeatedly and noninvasively are warranted. The goal of the present study was to measure changes in ratios of high energy phosphorus containing metabolites detected with in vivo 31Phosphorous Magnetic Resonance Spectroscopy ((31)P MRS) in a xenotransplantation model and to investigate if these ratios correlated to histological signs of acute xenograft rejection. Thirty-five heart transplantations were performed (NMRI-mice to Lewis (RT1(1)) rats). Thirteen heart transplants underwent repeated daily in vivo (31)P MRS measurements and 22 grafts were measured on any of 4 postoperative days and thereafter sacrificed for histology. A modified scoring system based on Billingham's criteria was used to stage the rejection process. The median graft survival was 3.0 +/- 0.44 (median +/- SD) days (n = 17). Significant differences, both overall and interday, could be calculated for the phosphocreatine (PCr)/beta-adenosine triphosphate (beta-ATP) ratios and for the rejection score. The decreases in PCr/beta-ATP ratios correlated significantly to the progressive acute rejection process in the sacrificed grafts (P = 0.01). Further studies are indicated to establish the potential of (31)P MRS in immunosuppressed recipients of vascularized xenotransplants with prolonged graft survival.

Acute Disease↗

PubMed2001

Laparoscopic or open surgery for living donor nephrectomy.

BACKGROUND: The anterior extraperitoneal approach for living donor nephrectomy has been used in more than 700 living cases in the unit and proved to be safe for the donor. In 1998, laparoscopic nephrectomy was introduced as an option when technically feasible. We found it essential to investigate the consequences of the new technique. SUBJECTS AND METHODS: One hundred living donor kidney transplantations were performed from 1998 to June 2000, 45 with laparoscopic, 55 with open nephrectomy. The donors took part in a structured interview 4 weeks after the donation and their responses were categorized in three classes. RESULTS: In each group, one recipient had delayed initial function. The serum creatinine levels after 3 and 7 days or the GFR values after 6 months did not differ. One graft has been lost following laparoscopic nephrectomy and four after open surgery. For the laparoscopy donors, the median number of post-operative days in hospital was 5.0 days (range 2-9), vs 6.0 (4-8) after open surgery (NS). The requirement of opoid analgesics post-operatively was 5.0 doses (1-22) vs 6.0 (1-38) (P=0.02); and after 4 weeks, 23 of 45 laparoscopic donors were free of pain vs eight of 55 open nephrectomy donors (P=0.0004). Approximately one-third of all donors felt some restriction of physical activity and the majority complained of impaired physical energy. There were no differences between the groups. The duration of sick-leave after laparoscopic surgery was median 6 (2-19) weeks vs 7 (1-16) (NS). CONCLUSIONS: Laparoscopic nephrectomy is safe. Less post-operative pain is a definite advantage for the donor.

Adult↗

PubMed2000

[Life as a gift--a group for public information on organ donation].

Explore the source record for details and available documents.

Humans↗

PubMed2000

[On history writing, comment II: Immunosuppressive agents are more important than tissue typing].

Explore the source record for details and available documents.

Histocompatibility Testing↗

PubMed2000

Liver transplantation for primary sclerosing cholangitis--a single-center experience.

The purpose of this study was to analyze the outcome of liver transplantation for primary sclerosing cholangitis (PSC) at our center. The medical records of 47 consecutive patients transplanted during the period 1985-1996 were reviewed. Actuarial patient survival was determined at 1, 5, and 10 years. Data on reasons for retransplantation, incidental carcinoma, biliary complications that required surgical intervention, and signs of possible disease recurrence were collected. The median follow-up period was 3.6 years. Overall patient survival was 75% at 1 year and 66% at 5 and 10 years. Patients transplanted during the period 1994-1996 (n = 24) had a significantly (P < 0.02) better 1 year (88% vs 61%) and 5-year (83% vs 48%) survival than patients transplanted during the period 1985-1993 (n = 23). Six patients (13%) were retransplanted, and 4 are currently alive. Nine patients (19%) had biliary complications that required surgical intervention. Cholangiocellular carcinoma was found in 4 (9%) explanted livers, and all 4 patients succumbed within 2 years of transplantation. Indications of disease recurrence were seen in 4 patients (9%). In conclusion, the results of liver transplantation for PSC at our center are comparable to those of other benign indications, but a relatively high incidence of biliary complications was noted, and a possible disease recurrence was detected in 9% of patients.

Actuarial Analysis↗

PubMed2000

Liver transplantation in patients over 60 years of age.

Liver transplantation was previously only offered to patients under 60 years of age. We have analyzed the outcome after acceptance on the waiting list and after liver transplantation of patients over 60 years old. A total of 150 patients over 60 years old were listed for a first liver transplantation during 1990-1998. The annual number increased throughout the period. Primary biliary cirrhosis, primary sclerosing cholangitis, and acute hepatic failure were the most frequent diagnoses. A total of 119 patients received a first liver allograft. The patient 1-year survival was 75% and 3-year survival 62%, which was not significantly lower (P = 0.21) than that of the younger patients. When correcting for year of transplantation, the survival was, however, moderately but significantly lower than among the younger patients. Survival among those > 65 years (n = 38) did not differ from that of patients 60-65 years of age (n = 81). We conclude that an increasing number of patients over 60 years old can be listed for liver transplantation and receive a liver allograft with highly satisfying results.

Age Distribution↗