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M Sterneck

Publications and source records attributed to M Sterneck.

47 records · Page 3Linked to original sources
PubMed1994

[The status of liver transplantation in therapy of hepatocellular carcinoma].

The state of the art in liver transplantation for hepatocellular carcinoma is presented through a review of our own data and the pertinent literature. Preoperative evaluation should stage the tumor precisely to allow therapeutic consequences to be drawn. The major obstacle is correct preoperative lymph node staging which is currently possible in less than 50% of the patients. If candidates are selected for transplantation, early vascular exclusion should be performed during the operation to prevent tumor cell dissemination. The results of recent reports on liver transplantation for hepatocellular carcinoma following strict selection criteria are encouraging. Patients with cirrhosis and hepatocellular carcinoma (diameter < 10 cm) fared significantly better after liver transplantation than after resection. Patients with uninodular or binodular disease and tumors smaller than 3 cm even showed a recurrence-free 3 year survival of 83% [3]. We conclude that for some patients liver transplantation offers the only chance for cure. Only prospective, controlled trials will define the patients that profit most from liver transplantation. The rising need for donor organs will currently restrict this modality to a highly selected group of patients. Once effective adjuvant therapies become available more patients might, however, become eligible.

Carcinoma, Hepatocellular↗
PubMed1992

Intragraft cytokine profile during human liver allograft rejection.

Forty-three human liver allograft biopsies and normal liver were directly analyzed for inflammatory and immunoregulatory cytokine gene expression by polymerase chain reaction (PCR). IL-5 gene expression was predominantly present in biopsies from liver allografts with histopathological evidence of acute rejection. IL-2 gene expression was rarely observed in rejecting allografts or allografts without evidence of rejection. In contrast, IL-4 message was readily detectable in the majority of liver allografts regardless of clinical status. The inflammatory mediators IL-1 beta, TNF-alpha, and IL-6 were detected with similar frequency in rejecting allografts and allografts without evidence of rejection. These findings suggest that inflammatory and immunoregulatory cytokines are produced within the allograft. Moreover, IL-5 may play a role in the local mechanisms of liver allograft rejection.

Base Sequence↗
PubMed1991

Azathioprine hepatotoxicity after liver transplantation.

We report the first two cases of apparent azathioprine hepatotoxicity occurring after liver transplantation. The two patients exhibited jaundice, elevated serum transaminase activities and histopathological features of sinusoidal congestion and centrilobular hepatocellular degeneration 17 and 61 days after transplantation. After withdrawal of azathioprine, liver test results improved immediately in both patients. Recurrence of liver injury after another challenge with azathioprine was seen in the first case. Previously, fatal venoocclusive disease occurring after kidney transplantation had been attributed to azathioprine. Irreversible venoocclusive disease and the reversible hepatotoxicity described in this report (i.e., sinusoidal congestion with centrizonal necrosis) most likely represent different stages of hepatic endotheliitis caused by azathioprine. Thus early diagnosis of azathioprine hepatotoxicity is of great importance.

Adult↗
PubMedDate not supplied

Liver graft infection by HBV S-gene mutants in transplant patients receiving long-term HBIg prophylaxis.

BACKGROUND/AIMS: HBV reinfection of transplant livers occurs frequently even in the presence of high doses of anti-HBs immunoglobulins. We analyzed, retrospectively, whether and which type of S-gene variants were selected by long-term polyclonal anti-HBs (HBIg) treatment leading to reinfection of patients transplanted because of chronic HBs-positive end-stage liver disease. METHODOLOGY: The preS2/S gene of the viral genomes obtained from sera before transplantation and during HBV reinfection was amplified by PCR and directly sequenced. RESULTS: According to transaminase and HBV DNA hybridization analysis, 3/18 (17%) liver transplant patients had HBV and hepatitis recurrence during anti-HBs therapy. A HBV S-gene mutant containing a G to A nucleotide mutation at position 587, converting Glycine to Arginine (G145A), was identified in all three patients as the dominant population at reinfection but not pre-transplantation. Contrary to the S-gene, no consistent nucleotide changes were found in the pre-S2 region of HBV genomes when comparing the reinfection and pre-transplantation samples. CONCLUSIONS: These data demonstrate that long-term polyclonal anti-HBs immunoprophylaxis selected the most commonly described G145R S-gene escape HBV variant which became the dominant virus population and was responsible for graft infection. Therefore, immunoglobulins with high affinity for the G145R HBs variant should be included in HBIg to prevent recurrent HBV infection in transplant patients.

Adult↗