Biomedical subjects

S Friman

Publications and source records attributed to S Friman.

At least 19 recordsLinked to original sources

PubMed2007

Successful combined partial auxiliary liver and kidney transplantation in highly sensitized cross-match positive recipients.

Combined liver and renal transplantations can be performed against a positive cross-match, indicating that the liver protects the kidney from the harmful HLA antibodies. This led us to the hypothesis that a partial auxiliary liver graft may have a similar protective effect when performed together with the kidney in highly sensitized patients. Seven patients, with broadly reacting HLA antibodies and positive crossmatches, were transplanted with a partial liver and a kidney from the same donor. In one of the cases a living donor was used. We performed lymphocytotoxic and flow cross-matches before and after the transplantation. Cross-matches turned negative after grafting in five of seven cases. The kidney function was excellent, without rejections, during the follow-up (24-60 months) in these patients. In two cases the cross-match remained positive after transplantation, one with a never-functioning renal graft and the other with an early graft failure, probably due to humoral rejection. A simultaneous transplantation of a partial auxiliary liver graft from the same donor, with the sole purpose of protecting the kidney from harmful lymphocytotoxic antibodies, can be performed successfully despite a positive cross-match and may thus be a new option of treatment for highly sensitized patients waiting for a kidney transplant.

Adult↗

PubMed2006

Extended right-sided liver resection for colorectal liver metastases--impact of percutaneous portal venous embolisation.

AIM: To compare the outcome after extended right liver lobe resection (ERL) for patients with liver metastases from colorectal cancer with preceding portal vein embolisation (PVE) with a non-PVE-group. METHODS: Nineteen patients underwent ERL (resection of segment 4-8) for colorectal liver metastases after PVE. They were compared with 21 patients that underwent an ERL without embolisation. A comparison was made with 84 patients undergoing right lobe liver resection during the same time period. Survival, post-operative morbidity and mortality were recorded and the volume of the future remnant liver (FRL) was measured with CT. RESULTS: There were major complications in 1/19 patients in the PVE-group and in 6/21 in the non-PVE-group (p=0.04). No post-operative deaths were observed in the PVE-group, compared to three deaths in the non-PVE-group (p=0.09). The median survival in the PVE-group was 32 months, which did not differ from the non-PVE-group. In 21% of the patients that underwent PVE, progression occurred during the time between embolisation and surgery. There was no difference in survival for patients that underwent PVE followed by ERL, compared to patients that underwent standard right lobe liver resection. CONCLUSION: The survival of patients after ERL is comparable with patients that undergo standard right lobe resection and have less liver tumour.

Colorectal Neoplasms↗

PubMed2006

Retransplantation of the liver.

Retransplantation (re-TX) is the only available therapy for irreversible liver graft dysfunction. The outcome of a second procedure depends upon several factors, some of which are not defined at the time of the decision to retransplant. This study is an analysis of all re-TX of the liver performed at our unit between January 1995 and January 2004. Among the 474 liver TX were 55 (11.6%) re-TX in 47 patients. We studied (1) diagnosis at first TX; (2) indication for re-TX and time lapse; (3) donor age and cold ischemia time (CIT); (4) duration of operation, peroperative bleeding, and complications; (5) ICU and ward periods; and (6) patient and graft survivals. Patients who underwent re-TX did not differ from those transplanted once with regard to age, gender, or diagnosis. The indications for re-TX were roughly one-third biliary tract complications/chronic rejection, one-third hepatic artery thrombosis, and one-third others, including primary nonfunction, acute rejection, portal vein thrombosis, sepsis, and B/C hepatitis. The re-TX were "urgent" in 29 and "elective" in 26 cases. Complications were common; about half of the patients were reoperated due to bleeding or biliary problems. To date (May 2004), 15 patients have died (12 "urgent" and 3 "elective"), of whom 5 had well functioning grafts. In summary, liver re-TX is a complicated procedure associated with significant mortality and morbidity, but considering that the actual patient group has a poor prognosis without re-TX, the results are nevertheless encouraging.

Adolescent↗

PubMed2006

Pharmacological preconditioning of rat liver by up-regulation of heme oxygenase 1.

PURPOSE: We investigated whether pharmacologically induced up-regulation of heme oxygenase 1 by pyrrolidine dithiocarbamate (PDTC) conferred protection against subsequent ischemia-reperfusion injury (IRI) to the rat liver after temporary vascular occlusion of 70% of the organ. METHODS: Female Wistar rats (200 to 250 g body weight) anesthetized with pentobarbitone were cannulated in the carotid artery and jugular vein. After laparotomy, a rubber band was applied around the entire vascular supply to the median and left lateral lobes, enabling vascular occlusion of 70% of the liver. A laser Doppler miniprobe was placed on the left lateral lobe to monitor peripheral liver blood flow (PLBF). Immediately upon completion of the surgery, the rats were administered either PDTC (50 mg/kg intravenously; n = 8) or its solvent (isotonic NaCl; n = 8). After 60 minutes, regional ischemia was induced for 30 minutes. The animals were then monitored for 2 hours of reperfusion. Blood samples for alanine transferase (ALT) estimation (as a measure of parenchymal injury) were drawn immediately prior to ischemia and reperfusion, as well as 60 and 120 minutes after reperfusion; PLBF was calculated at these times. RESULTS: ALT increased in the course of the experiments but there was no difference between the groups. The reduction in PBLF due to ischemia-reperfusion was significantly lower in the PDTC group: about 16% versus 40%, after 2 hours of reperfusion. CONCLUSION: Pretreatment with PDTC attenuated the disturbance of hepatic microcirculation, but not parenchymal injury, in the early phase of IRI.

Alanine Transaminase↗

PubMed2006

Successful ABO-incompatible liver transplantation using A2 donors.

INTRODUCTION: The longer waiting time for a liver graft among patients with blood group O makes it necessary to expand the donor pool for these patients. We herein have reported our experience with ABO-incompatible liver transplantation using A(2) donors to blood group O recipients. PATIENTS AND METHODS: Between 1996 to 2005, 10 adult blood group O recipients received 10 A(2) cadaveric grafts. Mean recipient age was 52 +/- 7.7 years (mean +/- SD). The initial immunosuppression was induction with antithymocyte globulin (n = 2), interleukin-2-receptor antagonists (n = 3), or anti-CD20 antibody (rituximab, n = 1), followed by a tacrolimus-based protocol. No preoperative plasmapheresis, immunoadsorption, or splenectomies were performed. RESULTS: Patient and graft survival was 10/10 and 8/10, respectively, at 8.5 months median follow-up (range 10 days to 109 months). Two patients were retransplanted because of bacterial arteritis (n = 1) and portal vein thrombosis (n = 1). The six acute rejections, which occurred in four patients, were all reversed by steroids or increased tacrolimus dosages. The pretransplant anti-A titers against A(1) red blood cells were 1:128 (NaCl technique) and 1:8 to 1024 (IAT technique). The maximum postoperative titers were 1:64 to 4000 (NaCl) and 1:256 to 32000 (IAT). CONCLUSION: The favorable outcome of A(2) to O grafting, with a patient survival of 10/10 and graft survival of 8/10, makes it possible to consider this blood group combination also in nonurgent situations. There was no hyperacute rejection or increased rate of rejections. Anti-A/B titer changes seem to not play a significant role in the monitoring of A(2) to O liver transplantation.

ABO Blood-Group System↗

PubMed2006

Pseudoaneurysm of the hepatic artery following liver transplantation.

We report 12 cases of pseudoaneurysm hepatic artery (PA) among 825 liver transplantations (OLT) performed between January 1985 and December 2005. In the early period (1985 to 1995), the incidence was 2.6% and in the later period (1996 to 2005), 0.9%. Median time to onset was 39.5 days post-OLT (range 14 days to 5 years). Six patients presented with rupture into the peritoneum (n = 4) or gastrointestinal tract (n = 2), while five patients presented with gastrointestinal bleed due arteriobiliary fistulation with hemobilia. The twelfth PA was found incidentally during retransplantation. PAs were detected with radiological imaging (n = 4), exploratory laparotomy (n = 6), at autopsy (n = 1) or at retransplantation (n = 1). We performed immediate revascularization, after surgical excision was performed in three and endovascular embolization in one patient. In six patients hepatic artery ligation without revascularization was inevitable with subsequent successful retransplantation in four patients. No PA-specific treatment was attempted in two cases due to the poor prognosis or diagnostic ambiguity. In 10 cases microbial pathogens were cultured in the blood, subhepatic abscesses, or from the wall of the hepatic artery. A hepaticojejunostomy was performed for biliary reconstruction in six patients and two had a hepaticojejunostomy conversion due to biliary leak. Survival in the early period (1985 to 1995) was 14%, whereas during the later period (1996 to 2005), the survival increased to 100% with a 4.2-year median follow-up (range 7.4 months to 6.9 years). Infrequently PA complicates OLT, becoming evident primarily after rupture with hemoperitoneum or a gastrointestinal bleed. Early recognition with angiography is important but acute hemorrhage often requires immediate exploration with ligation of the PA, although surgical or endovascular exclusion of the PA followed by revascularization provides a feasible treatment option.

Anastomosis, Surgical↗

PubMed2006

Late mortality in 679 consecutive liver transplant recipients: the Gothenburg liver transplant experience.

PURPOSE: Liver transplantation (OLT) is an established treatment with excellent early outcome. However, the long-term results are hampered by side effects of immunosuppression, cardiovascular morbidity, recurrent disease, and chronic rejection. We analyzed causes of late death (>/=2 years post-OLT) in 679 consecutive primary recipients in our institution. MATERIALS AND METHODS: A total of 679 primary OLT recipients including those retransplanted within 3 months between January 1985 and August 2005 were identified; 460 (67.7%) patients survived >/=2 years. The indications were cholestatic disease (35.1%), postviral (11.4%), alcoholic (12.9%), fulminant hepatic failure (7.0%), cryptogenic (3.1%), autoimmune hepatitis (4.8%), malignancy (7.7%), and others (18.0%). Sixty three patients (9.3%) died >/=2 years post-OLT. For 51 patients, sufficient records were present to establish the cause of death. RESULTS: Four hundred sixty (67.7%) patients survived >/=2 years. Their median age was 58 years with, 43.7% older than 60 and 11.1% older than 70 years. Sixty three patients (9.3%) died at a median time of 69 +/- 4.8 months post-primary OLT; 49.1% died of malignancy and 13.7% of vascular complications and infectious complications respectively. CONCLUSIONS: Late mortality in our material is mainly due to malignant disease. Compared to other published reports on late mortality, the proportion of malignancy, especially recurrent, as cause of late death is higher. This might reflect a more generous approach toward accepting older patients and a higher proportion of patients with various malignant diseases accepted for OLT.

Aged↗

PubMed2006

MELD [corrected] score in patients accepted for liver transplantation 1994 to 2004.

There has been a need to be able to grade the "degree of sickness" in patients with acute and chronic hepatic failure. The Model for End-Stage Liver Disease (MELD) score was developed as a tool to give a more objective estimate of the degree of sickness in patients with chronic liver disease. In this study the MELD score was compared retrospectively in adult patients accepted for liver transplantation (OLT) at our institution in 1994, 1999, and 2004. Gender, age, and MELD score associated with different indications for OLT were analyzed for the same period. The MELD scores were unchanged between the examined years, and there was no difference between male and female patients accepted for OLT. Comparing MELD score between male and female patients, there was a potential risk for discrimination of female patients due to their reduced muscle mass, resulting in a lower serum creatinine and a lower MELD score. There was no difference in MELD score comparing 1994, 1999, and 2004 for patients with cirrhosis. Patients with acute hepatic failure had the highest MELD scores while patients undergoing OLT because of malignancy had the lowest MELD score. MELD score seemed to be a useful tool for retrospective analyzes of potential OLT recipients.

Adult↗

PubMed2006

Early recurrence of nephrotic syndrome (immunoglobulin m nephropathy) after renal transplantation successfully treated with combinations of plasma exchanges, immunoglobulin, and rituximab.

In contrast to focal segmental glomerulosclerosis, which is well known to recur early in a renal graft, there are only few cases described with recurrence of immunoglobulin M (IgM) nephropathy after transplantation. We herein describe a patient with early recurrence of IgM nephropathy. A 15-year-old boy with nephrotic syndrome (IgM nephropathy) proceeding to end-stage renal disease was on dialysis before living related renal transplantation. Native kidneys were not removed. Standard immunosuppression including steroids, tacrolimus, and mycophenolate mofetil yielded initially good graft function with the s-creatinine falling to 73 micromol/L. Proteinuria was present on day 1, increasing to 20 g/L after 3 days. S-creatinine increased to 158 micromol/L and urine production diminished. A graft biopsy showed no rejection or glomerulopathy but protein vacuoles were seen within tubular cells indicating massive proteinuria. Treatment with plasma exchanges, immunoglobulin, and steroids was started. Hemodialysis was necessary. Proteinuria improved to 3.5 g/L, but s-creatinine continued to rise and a second graft biopsy showed vascular rejection (Banff type IIA). The patient was treated with antithymocyte globulin and further plasma exchanges. A single dose of rituximab was given. Five months after transplantation the s-creatinine was 67 micromol/L and there was no proteinuria. In this case early recurrence of nephrotic syndrome occurred on the first posttransplant day in combination with later occurring vascular rejection. Successful treatment included a combination of plasma exchanges, rituximab, immunoglobulin, and antithymocyte globulin.

Adolescent↗

PubMed2006

The cadaveric organ donor program at Sahlgrenska University Hospital, 1977 to 2005.

The transplantation program with cadaveric organs has been ongoing at our institution for more than 40 years, since 1965. The purpose of this report was to analyze changes in the donor population and causes of death over the years. This retrospective analysis of donor records between 1977 and 2005, included 1331 donors. Since 1977, the number of donors has remained unchanged, but their profile has changed. The median donor age today has almost doubled, from 30 to nearly 60 years. Early on the most common cause of death was head trauma and the majority of donors were men. Since the mid-1980s, the main cause of death was intracerebral hemorrhage or cerebral thrombosis and the gender distribution became equal. The number of procured and transplanted organs from each donor has increased, despite an increased donor age. The multi-organ donor rate exceeded 80% in the beginning of this decade; we retrieved 3.9 organs per donor. These results may be explained by improved organ donor care and organization, and by increased awareness of potential donors among elderly patients.

Adolescent↗

PubMed2006

Effect of remote preconditioning on mild or severe ischemia-reperfusion injury to rat liver.

UNLABELLED: In this study we examined the effect of remote ischemic preconditioning (RIPC) on liver ischemia-reperfusion (IR) injury. Anesthetized Wistar rats (200 to 250 g body weight, n = 32) had the right femoral artery (FA) dissected. Protocol I. The hepatic artery (HA) was clamped for 60 minutes; peripheral liver blood flow (PLBF) and alanine aminotransferase (ALT) were measured prior to clamping as well as 60 minutes after reperfusion. The cohorts were group 1 (no RIPC; n = 10) and group 2 (RIPC; n = 10) 35 minutes after surgery, the FA was clamped for 10 minutes. After 15 minutes, the HA was clamped as in group 1. In protocol II, a rubber band was applied around the entire vascular supply to about 70% of the liver, yielding group 3 (no RIPC; n = 6) that 60 minutes after surgery, had vascular occlusion performed for 30 minutes and group 4 (RIPC; n = 6) with the FA clamped as above, in a procedure otherwise identical to that of group 3. RESULTS: In protocol I, there was no significant difference in PLBF between the two groups after reperfusion, but the increased ALT levels in the RIPC group were reduced (.70 +/- .05 vs. 1.0 +/- .15 microkat/L, P = .049). In protocol II, we observed no significant differences in ALT levels or PLBF between the two groups. Thus, a beneficial effect of RIPC was demonstrated in protocol I with relative hypoxemia to the liver. However, the effect could not be demonstrated in protocol II, which induced a more severe IR injury.

Alanine Transaminase↗

PubMed2006

Outcome of renal transplantation subsequent to liver, heart, or lung transplantation.

Renal dysfunction is a growing problem after liver, heart, or lung transplantation with the subsequent need for dialysis or renal transplantation. The aim of this study was to analyze the outcome after a subsequent kidney transplantation (secondary kidney transplantation) in liver, heart, or lung transplantation recipients. All secondary kidney transplantation patients from 1985 to 2006 were identified for the cause of kidney failure, time after initial transplantation, and current kidney function. One thousand two hundred three patient charts were reviewed including 22 (1.8%) secondary kidney transplantations: eight after lung, eight after heart, and six after liver transplantation. Renal failure was the result of perioperative renal failure (n = 3), toxic effects of cyclosporine (n = 16), a combination of cyclosporine nephrotoxicity and vascular ischemia (n = 3), or chronic renal failure due to polycystic kidney disease (n = 1). The median time after the initial organ transplantation was 114 months (range 30 to 241 months). The most recent median creatinine value was 103 micromol/L (82 to 704 micromol/L). Renal transplant rejection was noted in five patients: four in the lung transplant group, and one after heart transplantation. Three patients were deceased, one from secondary renal failure. One renal allograft was removed after renal artery thrombosis. In conclusion, there is sometimes a need for subsequent kidney transplantation after liver, heart, or lung transplantation. The outcome of renal transplantation subsequent to liver, heart, or lung transplantation is good with satisfactory renal function in this study population.

Heart Transplantation↗

PubMed2006

A prospective, randomized, multicenter trial of tacrolimus-based therapy with or without basiliximab in pediatric renal transplantation.

In a 6-month, multicenter, randomized, controlled, open-label, parallel-group trial, we investigated the efficacy and safety of adding basiliximab to a standard tacrolimus-based regimen in pediatric renal transplant recipients. Patients < 18 years received tacrolimus/azathioprine/steroids (TAS, n = 93) or tacrolimus/azathioprine/steroids/basiliximab (TAS + B, n = 99). Target tacrolimus levels were 10-20 ng/mL between days 0-21 and 5-15 ng/mL thereafter. Steroid dosing was identical in both groups. Basiliximab was administered at 10 mg (patients < 40 kg) or 20 mg (patients > or = 40 kg) within 4 h of reperfusion; the same dose was repeated on day 4. Biopsy-proven acute rejection rates were 20.4% (TAS) and 19.2% (TAS + B); steroid-resistant acute rejection rates were 3.2% and 3.0%, respectively. Patient survival was 100%; graft survival rates were 95% in both arms. The nature and incidence of adverse events were similar in both arms except toxic nephropathy and abdominal pain, which were significantly higher in the TAS + B arm (14.1% vs. 4.3%; p = 0.03 and 11.1% vs. 2.2%; p = 0.02; respectively). Median serum creatinine concentrations at 6 months were 86 micromol/L in the TAS and 91 micromol/L in the TAS + B arm; glomerular filtration rate was 79.4 and 77.6 (mL/min/1.73 m2), respectively. Adding basiliximab to a tacrolimus-based regimen is safe in pediatric patients, but does not improve clinical efficacy.

Adolescent↗

PubMed2005

Prospective, multicenter, randomized trial to compare incidence of new-onset diabetes mellitus and glucose metabolism in patients receiving cyclosporine microemulsion versus tacrolimus after de novo kidney transplantation.

New-onset diabetes mellitus (NODM) is associated with increased risk of graft failure and death in renal transplant recipients. Some clinical studies have indicated that NODM risk is higher with tacrolimus than cyclosporine, but no comparative trial has used American Diabetic Association (ADA)/World Health Organization (WHO) criteria for diagnosis of diabetes mellitus. The Diabetes Incidence After Renal Transplantation, Neoral C2 Monitoring Versus Tacrolimus (DIRECT) study is a 6-month open-label, multicenter trial comparing the impact of tacrolimus and Neoral (cyclosporine microemulsion) on glucose metabolism in 700 de novo kidney transplant recipients, based on ADA/WHO criteria. Patients are randomized to tacrolimus (C0 monitoring) or Neoral (C2 monitoring), stratified by baseline diabetic status and ethnicity. All patients receive basiliximab, corticosteroids, and mycophenolate mofetil or enteric-coated mycophenolate acid (myfortic). Pooled interim 3-month results from a subset of 115 patients receiving either tacrolimus or Neoral showed that the primary efficacy end-point (biopsy-proven acute rejection [BPAR], graft loss or death) occurred in 11 patients (10%). There were four graft losses and only one death, which occurred after graft loss. Eight patients experienced BPAR (7.3%). Among 99 patients who were nondiabetic at baseline, 14 developed NODM by month 3, 17 developed impaired fasting glucose or impaired glucose tolerance, and another 5 patients received hypoglycemic treatment for at least 14 consecutive days or at the month 3 visit, resulting in a 36% incidence of impaired glucose metabolism. At 3 months, median GFR (Nankivell) was 63.7 mL/min; median serum creatinine was 137 micromol/L. Full complete results are expected in December 2005.

Adrenal Cortex Hormones↗

PubMed2005

Preemptive therapy with pegylated interferon alpha-2b and ribavirin after liver transplantation for hepatitis C cirrhosis.

UNLABELLED: We present our results of preemptive treatment with pegylated interferon and ribavirin after liver transplantation for hepatitis C cirrhosis. PATIENTS: Between September 2001 and August 2002, four patients were started on combination therapy with pegylated interferon-alpha-2b (1microg/kg weekly) and ribavirin (400-1000 mg/d) 3 to 4 weeks' posttransplant. Treatment was continued for 6 (genotype 3a, 2 patients) or 12 (genotype 1b, 2 patients) months. Virologic and biochemical responses as well as side effects were evaluated. RESULTS: Two patients (genotype 3a) became HCV (hepatitis C virus)-RNA negative after 3 months of therapy and are persistently negative 20 and 14 months after end of therapy. One patient (genotype 1b) became HCV-RNA negative 6 months after start of treatment, but therapy had to be withdrawn after 9 months owing to fatigue and suspicion of angina pectoris. One patient who was later retransplanted because of hepatic artery thrombosis discontinued therapy after 2.5 months owing to anemia, leukopenia, and no signs of HCV-RNA reduction. Interestingly, two of the responders were nonresponders prior to liver transplant. Median ALT levels at start of therapy were 98 U/L (r = 60-126) and 12 months later 40 U/L (r = 24-58) (n = 4). No rejection episode was detected. CONCLUSION: In patients liver-transplanted due to HCV-cirrhosis, combination therapy with pegylated interferon and ribavirin can be effective and safe in the early posttransplant period, thus preventing recurrent hepatitis C.

Antiviral Agents↗

PubMed2005

Recurrence of hepatitis C after liver transplantation.

Cirrhosis due to hepatitis C is currently the most common indication for liver transplantation in the United States as well as in Europe. The prognosis for patients transplanted due to hepatitis C has changed over the years. Today there is growing concern as to the prognosis of these patients and how we should treat them. This is an overview of the developments in this field concerning treatment of recurrence and the role of preemptive treatment.

Antiviral Agents↗

PubMed2005

Selected activities in Scandiatransplant.

Scandiatransplant is the Nordic organ exchange organization. It has existed for 35 years and it is owned by all organ transplantation hospital departments in the five Nordic countries--Denmark, Finland, Iceland, Norway, and Sweden. The use of living organ donors for kidney transplantation has become a more common procedure not only in Norway but also in Sweden and Denmark. For the first time, in 2003, one transplant center performed relatively more living donor kidney transplantations than with deceased donors. The overall organ transplant activity reveals a remarkably stable situation in the area covered by Scandiatransplant. Scandiatransplant as an organ exchange organization has changed from a solely kidney exchange organization to an organization in which the more immediate vital organs as liver and heart are exchanged more commonly than kidneys.

Humans↗

PubMed2005

Nitric oxide-mediated effects on liver blood flow.

We investigated whether blockade of nitric oxide synthase by the arginine analog l- NAME could affect peripheral liver blood flow (PLBF) or hepatocyte integrity (serum ALT) in either a control series or in a series subjected to mild reduction of liver blood flow by temporary clamping of the hepatic artery (HA). Anesthetized rats were arranged for mean arterial pressure (MAP) recordings via a carotid artery, drug injections, and blood sampling via a jugular vein, and monitoring of PLBF using a laser Doppler flowmeter. In series 1, the rats received either l-NAME (30 mg/kg i.v.) or NaCl. l-NAME caused a significant decrease in PLBF and an increase in MAP compared to NaCl; ALT did not differ. In series 2, l-NAME (30 mg/kg i.v.) or NaCl was administered at the beginning of the experiment. After 60 minutes of equilibration, the HA was clamped for 60 minutes then unclamped for another 60 minutes. As in series 1, the l-NAME group had significantly lower PLBF and higher MAP than the NaCl group. Occlusion of the HA resulted in significantly greater reduction in PLBF in the NaCl versus the l-NAME group. Upon unclamping, there was no difference in ALT levels, PLBF, or MAP. To conclude, NO displayed a positive tonic effect on liver blood flow, reduction of which with l-NAME did not aggravate mild ischemia/reperfusion injury in this model.

Animals↗