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Dr. Dennis Eurich
Department of Surgery, Campus Charité Mitte, Campus Virchow‐Klinikum, Charité–Universitätsmedizin Berlin, Berlin, Germany

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0 Hepatitis
0 Hepatocellular carcinoma
0 Liver Diseases
0 liver surgery
0 Liver cirrhosis liver transplantation

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Hepatitis
Hepatocellular carcinoma
Liver Diseases
liver surgery

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Journal article
Published: 13 August 2021 in Medicina
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Background and objectives Budd-Chiari syndrome (BCS) refers to a complete thrombotic obstruction of the venous hepatic outflow tract due to various etiologies and constitutes a rare indication for ortothopic liver transplantation (LT). Few studies investigated long-term outcomes after LT for BCS. The aim of this study was to examine potential risk factors for late mortality and to evaluate long-term outcomes after LT for BCS. Materials and methods: 46 patients received an LT for BCS between 1989 and 2019 at the transplant center of the Charité-Universitätsmedizin Berlin. We analyzed potential effects of disease etiology, vascular events, rejection, and immunosuppression on long-term survival after transplantation using Kaplan-Meier curves and Cox logistic regression. Results: Of the 46 patients, 70% were female and 30% were male. Median age at the time of transplantation was 36 years. A total of 41 vascular events, including 26 thrombotic and 17 hemorrhagic incidents, occurred. The 1 year, the 5 year, the 10 year, and the 20 year survival rates were 87%, 83%, 76%, and 60%, respectively. By comparison, survival rates of the liver transplant cohort across all other indications at our center were slightly inferior with 85%, 75%, 65%, and 46%, respectively. In the study population, patients with myeloproliferative disorders showed worse outcomes compared to patients with other causes of BCS. Conclusion: Liver transplantation for BCS showed excellent results, even superior to those for other indications. Vascular events (i.e., thrombotic or hemorrhagic complications) did not have any prognostic value for overall mortality. Patients with myeloproliferative disorders seem to have a disadvantage in survival.

ACS Style

Marius Ibach; Dennis Eurich; Eva Dobrindt; Georg Lurje; Wenzel Schöning; Robert Öllinger; Johann Pratschke; Brigitta Globke. Orthotopic Liver Transplantation for Budd-Chiari Syndrome: Observations from a 30-Year Liver Transplant Program. Medicina 2021, 57, 821 .

AMA Style

Marius Ibach, Dennis Eurich, Eva Dobrindt, Georg Lurje, Wenzel Schöning, Robert Öllinger, Johann Pratschke, Brigitta Globke. Orthotopic Liver Transplantation for Budd-Chiari Syndrome: Observations from a 30-Year Liver Transplant Program. Medicina. 2021; 57 (8):821.

Chicago/Turabian Style

Marius Ibach; Dennis Eurich; Eva Dobrindt; Georg Lurje; Wenzel Schöning; Robert Öllinger; Johann Pratschke; Brigitta Globke. 2021. "Orthotopic Liver Transplantation for Budd-Chiari Syndrome: Observations from a 30-Year Liver Transplant Program." Medicina 57, no. 8: 821.

Journal article
Published: 28 July 2021 in Medicina
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Background and Objectives: Development of hepatitis-B is considered a serious complication after liver transplantation. HBV de novo infection is a rather rare phenomenon, however it deserves attention in the era of donor organ shortage. The aim of the present analysis was to examine its course in liver transplant patients. Materials and Methods: Prevalence of de novo HBV-infections was extracted from our local transplant data base. Analysis focused on the moment of HBV-detection and on the long-term follow-up in terms of biochemical and histological changes over 30 years. Results: 46 patients were identified with the diagnosis of de novo hepatitis B. Median time from liver transplantation to diagnosis was 397 days (7–5505). 39 patients received antiviral therapy. No fibrosis progression could be detected, whereas the grade of inflammation significantly lessened from the moment of HBV detection to the end of histological follow-up over a median of 4344 days (range 123–9490). Patients with a poor virological control demonstrated a significantly poorer overall survival. Conclusions: De novo hepatitis B in liver transplant patients is a condition that can be controlled very well without significant fibrosis progression or graft loss if recognized on time within a regular transplant follow-up schedule.

ACS Style

Ramin Raul Ossami Saidy; Franziska Eurich; Maximilian Paul Postel; Eva Maria Dobrindt; Jasper Feldkamp; Selina Johanna Schaper; Johann Pratschke; Brigitta Globke; Dennis Eurich. Clinical and Histological Long-Term Follow-Up of De Novo HBV-Infection after Liver Transplantation. Medicina 2021, 57, 767 .

AMA Style

Ramin Raul Ossami Saidy, Franziska Eurich, Maximilian Paul Postel, Eva Maria Dobrindt, Jasper Feldkamp, Selina Johanna Schaper, Johann Pratschke, Brigitta Globke, Dennis Eurich. Clinical and Histological Long-Term Follow-Up of De Novo HBV-Infection after Liver Transplantation. Medicina. 2021; 57 (8):767.

Chicago/Turabian Style

Ramin Raul Ossami Saidy; Franziska Eurich; Maximilian Paul Postel; Eva Maria Dobrindt; Jasper Feldkamp; Selina Johanna Schaper; Johann Pratschke; Brigitta Globke; Dennis Eurich. 2021. "Clinical and Histological Long-Term Follow-Up of De Novo HBV-Infection after Liver Transplantation." Medicina 57, no. 8: 767.

Journal article
Published: 13 May 2021 in Viruses
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Patients after LT due to combined HBV/HDV infection are considered to be high-risk patients for recurrence of hepatitis B and D. To date, life-long prophylaxis with hepatitis B immunoglobulin (HBIG) and replication control with nucleos(t)ide analogs (NA) remains standard. We examined the course of 36 patients that underwent liver transplantation from 1989 to 2020 for combined HBV/HDV-associated end-stage liver disease in this retrospective study. Seventeen patients eventually discontinued HBIG therapy for various reasons. Their graft function, histopathological findings from routine liver biopsies and overall survival were compared with those that received an unaltered NA-based standard regimen combined with HBIG. The median follow-up was 204 and 227 months, respectively. The recurrence of HBV was 25% and did not differ between the groups of standard reinfection prophylaxis NA/HBIG (21.1%) and HBIG discontinuation (29.4%); (p = 0.56). No significant differences were found regarding the clinical course or histopathological aspects of liver tissue damage (inflammation, fibrosis, steatosis) between these two groups. Overall, and adjusted survival did not differ between the groups. Discontinuation of HBIG in stable patients after LT for combined HBV/HDV did not lead to impaired overall survival or higher recurrence rate of HBV/HDV infection in this long-term follow-up. Therefore, the recommendation of the duration of HBG administration must be questioned. The earliest time of discontinuation remains unclear.

ACS Style

Ramin Ossami Saidy; Irina Sud; Franziska Eurich; Mustafa Aydin; Maximilian Postel; Eva Dobrindt; Johann Pratschke; Dennis Eurich. Discontinuation of Passive Immunization Is Safe after Liver Transplantation for Combined HBV/HDV Infection. Viruses 2021, 13, 904 .

AMA Style

Ramin Ossami Saidy, Irina Sud, Franziska Eurich, Mustafa Aydin, Maximilian Postel, Eva Dobrindt, Johann Pratschke, Dennis Eurich. Discontinuation of Passive Immunization Is Safe after Liver Transplantation for Combined HBV/HDV Infection. Viruses. 2021; 13 (5):904.

Chicago/Turabian Style

Ramin Ossami Saidy; Irina Sud; Franziska Eurich; Mustafa Aydin; Maximilian Postel; Eva Dobrindt; Johann Pratschke; Dennis Eurich. 2021. "Discontinuation of Passive Immunization Is Safe after Liver Transplantation for Combined HBV/HDV Infection." Viruses 13, no. 5: 904.

Journal article
Published: 31 March 2021 in Cancers
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Introduction: Recurrence of hepatocellular carcinoma (rHCC) after liver transplantation (LT) is associated with limited survival. Therefore, identification of factors that prolong survival in these patients is of great interest. Surgical resection, radiotherapy, and transarterial chemoembolization (TACE) are established interventions to improve outcomes in these patients; however, the impact of immunosuppression is unknown. Methods: All patients diagnosed with rHCC in the follow-up after LT were identified from a database of liver recipients transplanted between 1988 and 2019 at our institution (Charité Universitätsmedizin Berlin, Germany). Based on the immunosuppressive regimen following diagnosis of rHCC and the oncological treatment approach, survival analysis was performed. Results: Among 484 patients transplanted for HCC, 112 (23.1%) developed rHCC in the follow-up. Recurrent HCC was diagnosed at a median interval of 16.0 months (range 1.0–203.0), with the majority presenting early after transplantation (63.0%, <2 years). Median survival after rHCC diagnosis was 10.6 months (0.3–228.7). Reduction of immunosuppression was associated with improved survival, particularly in patients with palliative treatment (8.4 versus 3.0 months). In addition, greater reduction of immunosuppression seemed to be associated with greater prolongation of survival. Graft rejection after reduction was uncommon (n = 7, 6.8%) and did not result in any graft loss. Patients that underwent surgical resection showed improved survival rates (median 19.5 vs. 8.7 months). Conclusion: Reduction of immunosuppressive therapy after rHCC diagnosis is associated with prolonged survival in LT patients. Therefore, reduction of immunosuppression should be an early intervention following diagnosis. In addition, surgical resection should be attempted, if technically feasible and oncologically meaningful.

ACS Style

Ramin Ossami Saidy; Maximilian Postel; Michael Pflüger; Wenzel Schoening; Robert Öllinger; Safak Gül-Klein; Moritz Schmelzle; Frank Tacke; Johann Pratschke; Dennis Eurich. Minimization of Immunosuppressive Therapy Is Associated with Improved Survival of Liver Transplant Patients with Recurrent Hepatocellular Carcinoma. Cancers 2021, 13, 1617 .

AMA Style

Ramin Ossami Saidy, Maximilian Postel, Michael Pflüger, Wenzel Schoening, Robert Öllinger, Safak Gül-Klein, Moritz Schmelzle, Frank Tacke, Johann Pratschke, Dennis Eurich. Minimization of Immunosuppressive Therapy Is Associated with Improved Survival of Liver Transplant Patients with Recurrent Hepatocellular Carcinoma. Cancers. 2021; 13 (7):1617.

Chicago/Turabian Style

Ramin Ossami Saidy; Maximilian Postel; Michael Pflüger; Wenzel Schoening; Robert Öllinger; Safak Gül-Klein; Moritz Schmelzle; Frank Tacke; Johann Pratschke; Dennis Eurich. 2021. "Minimization of Immunosuppressive Therapy Is Associated with Improved Survival of Liver Transplant Patients with Recurrent Hepatocellular Carcinoma." Cancers 13, no. 7: 1617.

Journal article
Published: 24 February 2021 in Journal of Clinical Medicine
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Background: Cardiac function can be influenced by liver cirrhosis and should be thoroughly evaluated before liver transplantation. We investigated left ventricular (LV) and, for the first time, left atrial (LA) strain and strain rate in end-stage liver cirrhosis patients of different etiologies. Methods: This retrospective, cross-sectional study evaluated left heart function in 80 cirrhosis patients and 30 controls using standardized echocardiographic techniques and speckle tracking technology (STE) analysis. Serum markers of liver function were used for correlation analysis. Results: While conventional parameters demonstrated no alteration in systolic function, speckle tracking analysis showed a significant increase in LV longitudinal strain throughout all cardiac layers, with significant correlation to model of end-stage liver disease (MELD) score. LA reservoir and conduit strain as well as LA strain rate in all phases were significantly reduced in end-stage liver disease (ESLD) patients compared to control. STE for the evaluation of LA phasic function seemed to be more sensitive than volumetric methods. Kaplan-Meier curves showed a trend towards reduced post-transplant survival in patients with a reduced LA reservoir and conduit strain. Conclusion: STE analysis detected increased LV and decreased LA deformation in cirrhosis patients, thus proving to be highly sensitive to cardiac changes and useful for more precise cardiac evaluation.

ACS Style

Franzisca von Köckritz; Alexander Braun; Rosa Schmuck; Eva Dobrindt; Dennis Eurich; Frank Heinzel; Burkert Pieske; Felicitas Escher; Kun Zhang. Speckle Tracking Analysis Reveals Altered Left Atrial and Ventricular Myocardial Deformation in Patients with End-Stage Liver Disease. Journal of Clinical Medicine 2021, 10, 897 .

AMA Style

Franzisca von Köckritz, Alexander Braun, Rosa Schmuck, Eva Dobrindt, Dennis Eurich, Frank Heinzel, Burkert Pieske, Felicitas Escher, Kun Zhang. Speckle Tracking Analysis Reveals Altered Left Atrial and Ventricular Myocardial Deformation in Patients with End-Stage Liver Disease. Journal of Clinical Medicine. 2021; 10 (5):897.

Chicago/Turabian Style

Franzisca von Köckritz; Alexander Braun; Rosa Schmuck; Eva Dobrindt; Dennis Eurich; Frank Heinzel; Burkert Pieske; Felicitas Escher; Kun Zhang. 2021. "Speckle Tracking Analysis Reveals Altered Left Atrial and Ventricular Myocardial Deformation in Patients with End-Stage Liver Disease." Journal of Clinical Medicine 10, no. 5: 897.

Journal article
Published: 09 December 2020 in Journal of Clinical Medicine
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Donor-specific anti-human leukocyte antigen antibodies (DSA) are controversially discussed in the context of liver transplantation (LT). We investigated the relationship between the presence of DSA and the outcome after LT. All the LTs performed at our center between 1 January 2008 and 31 December 2015 were examined. Recipients < 18 years, living donor-, combined, high-urgency-, and re-transplantations were excluded. Out of 510 LTs, 113 DSA-positive cases were propensity score-matched with DSA-negative cases based on the components of the Balance of Risk score. One-, three-, and five-year survival after LT were 74.3% in DSA-positive vs. 84.8% (p = 0.053) in DSA-negative recipients, 71.8% vs. 71.5% (p = 0.821), and 69.3% vs. 64.9% (p = 0.818), respectively. Rejection therapy was more often applied to DSA-positive recipients (n = 77 (68.1%) vs. 37 (32.7%) in the control group, p < 0.001). At one year after LT, 9.7% of DSA-positive patients died due to sepsis compared to 1.8% in the DSA-negative group (p = 0.046). The remaining causes of death were comparable in both groups (cardiovascular 6.2% vs. 8.0%; p = 0.692; hepatic 3.5% vs. 2.7%, p = 0.788; malignancy 3.5% vs. 2.7%, p = 0.788). DSA seem to have an indirect effect on the outcome of adult LTs, impacting decision-making in post-transplant immunosuppression and rejection therapies and ultimately increasing mortality due to infectious complications.

ACS Style

Sinem Ünlü; Nils Lachmann; Maximilian Jara; Paul Viktor Ritschl; Leke Wiering; Dennis Eurich; Christian Denecke; Matthias Biebl; Sascha Chopra; Safak Gül-Klein; Wenzel Schöning; Moritz Schmelzle; Petra Reinke; Frank Tacke; Johann Pratschke; Robert Öllinger; Tomasz Dziodzio. Treatment of Anti-HLA Donor-Specific Antibodies Results in Increased Infectious Complications and Impairs Survival after Liver Transplantation. Journal of Clinical Medicine 2020, 9, 3986 .

AMA Style

Sinem Ünlü, Nils Lachmann, Maximilian Jara, Paul Viktor Ritschl, Leke Wiering, Dennis Eurich, Christian Denecke, Matthias Biebl, Sascha Chopra, Safak Gül-Klein, Wenzel Schöning, Moritz Schmelzle, Petra Reinke, Frank Tacke, Johann Pratschke, Robert Öllinger, Tomasz Dziodzio. Treatment of Anti-HLA Donor-Specific Antibodies Results in Increased Infectious Complications and Impairs Survival after Liver Transplantation. Journal of Clinical Medicine. 2020; 9 (12):3986.

Chicago/Turabian Style

Sinem Ünlü; Nils Lachmann; Maximilian Jara; Paul Viktor Ritschl; Leke Wiering; Dennis Eurich; Christian Denecke; Matthias Biebl; Sascha Chopra; Safak Gül-Klein; Wenzel Schöning; Moritz Schmelzle; Petra Reinke; Frank Tacke; Johann Pratschke; Robert Öllinger; Tomasz Dziodzio. 2020. "Treatment of Anti-HLA Donor-Specific Antibodies Results in Increased Infectious Complications and Impairs Survival after Liver Transplantation." Journal of Clinical Medicine 9, no. 12: 3986.

Journal article
Published: 17 November 2020 in Journal of Clinical Medicine
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Although more than one million liver transplantations have been carried out worldwide, the literature on liver resections in transplanted livers is scarce. We herein report a total number of fourteen patients, who underwent liver resection after liver transplantation (LT) between September 2004 and 2017. Hepatocellular carcinomas and biliary tree pathologies were the predominant indications for liver resection (n = 5 each); other indications were abscesses (n = 2), post-transplant lymphoproliferative disease (n = 1) and one benign tumor. Liver resection was performed at a median of 120 months (interquartile range (IQR): 56.5–199.25) after LT with a preoperative Model for End-Stage Liver Disease (MELD) score of 11 (IQR: 6.75–21). Severe complications greater than Clavien–Dindo Grade III occurred in 5 out of 14 patients (36%). We compared liver resection patients, who had a treatment option of retransplantation (ReLT), with actual ReLTs (excluding early graft failure or rejection, n = 44). Bearing in mind that late ReLT was carried out at a median of 117 months after first transplantation and a median of MELD of 32 (IQR: 17.5–37); three-year survival following liver resection after LT was similar to late ReLT (50.0% vs. 59.1%; p = 0.733). Compared to ReLT, liver resection after LT is a rare surgical procedure with significantly shorter hospital (mean 25, IQR: 8.75–49; p = 0.034) and ICU stays (mean 2, IQR: 1–8; p < 0.001), acceptable complications and survival rates.

ACS Style

Julian M. O. Pohl; Nathanael Raschzok; Dennis Eurich; Michael Pflüger; Leke Wiering; Assal Daneshgar; Tomasz Dziodzio; Maximilian Jara; Brigitta Globke; Igor M. Sauer; Matthias Biebl; Georg Lurje; Wenzel Schöning; Moritz Schmelzle; Frank Tacke; Johann Pratschke; Paul V. Ritschl; Robert Öllinger. Outcomes of Liver Resections after Liver Transplantation at a High-Volume Hepatobiliary Center. Journal of Clinical Medicine 2020, 9, 3685 .

AMA Style

Julian M. O. Pohl, Nathanael Raschzok, Dennis Eurich, Michael Pflüger, Leke Wiering, Assal Daneshgar, Tomasz Dziodzio, Maximilian Jara, Brigitta Globke, Igor M. Sauer, Matthias Biebl, Georg Lurje, Wenzel Schöning, Moritz Schmelzle, Frank Tacke, Johann Pratschke, Paul V. Ritschl, Robert Öllinger. Outcomes of Liver Resections after Liver Transplantation at a High-Volume Hepatobiliary Center. Journal of Clinical Medicine. 2020; 9 (11):3685.

Chicago/Turabian Style

Julian M. O. Pohl; Nathanael Raschzok; Dennis Eurich; Michael Pflüger; Leke Wiering; Assal Daneshgar; Tomasz Dziodzio; Maximilian Jara; Brigitta Globke; Igor M. Sauer; Matthias Biebl; Georg Lurje; Wenzel Schöning; Moritz Schmelzle; Frank Tacke; Johann Pratschke; Paul V. Ritschl; Robert Öllinger. 2020. "Outcomes of Liver Resections after Liver Transplantation at a High-Volume Hepatobiliary Center." Journal of Clinical Medicine 9, no. 11: 3685.

Short communication
Published: 04 August 2020 in Transplant Infectious Disease
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Background A self‐limited hepatitis B infection can reactivate in patients under immunosuppression or chemotherapy (reappearance of hepatitis B surface antigen (HBsAg) or HBV DNA). Exact circumstances of HBV reactivation in patients undergoing liver transplantation (LT) for end stage liver diseases (ESLD) unrelated to HBV are unknown and recommendations on HBV prophylaxis remain unclear. Patients and methods Among 1273 liver transplants, 168 patients with a self‐limited HBV hepatitis B infection prior to LT were identified from our prospective liver transplant database. Patients with underlying chronic HBV infection and recipients of an anti‐HBc‐positive liver were not included in the analysis. Demographic, laboratory, serological and virological data were analyzed retrospectively. Appearance of HBsAg or HBV‐DNA were defined as reactivation. Results The median follow‐up after LT was 12.0 years (0.6‐30.7 years). The rate of HBV reactivation was 0% independent of antiviral prophylaxis (n=7; 4.2%), the etiology of ESLD, hepatitis C treatment or the anti‐HBs concentration. The overall patient survival with a history of a self‐limited HBV infection before LT did not significantly differ from the rest of the cohort. Conclusion Antiviral treatment with nucleos(t)ide analogues post liver transplantation in order to prevent HBV reactivation in patients with a resolved self‐limited hepatitis B infection prior to LT seems to be omittable since the main viral reservoir is removed by the hepatectomy. These findings may clarify the current uncertainty in the recommendations regarding the risk of HBV reactivation in patients with self‐limited hepatitis B prior to LT.

ACS Style

Ramin Raul Ossami Saidy; Muenevver Demir; Pauline Nibbe; Eva‐Maria Dobrindt; Robert Oellinger; Wenzel Schoening; Johann Pratschke; Dennis Eurich. Self‐limited HBV infection of the recipient does not reactivate after liver transplantation: Observations from a 30‐year liver transplant program. Transplant Infectious Disease 2020, 23, 1 .

AMA Style

Ramin Raul Ossami Saidy, Muenevver Demir, Pauline Nibbe, Eva‐Maria Dobrindt, Robert Oellinger, Wenzel Schoening, Johann Pratschke, Dennis Eurich. Self‐limited HBV infection of the recipient does not reactivate after liver transplantation: Observations from a 30‐year liver transplant program. Transplant Infectious Disease. 2020; 23 (1):1.

Chicago/Turabian Style

Ramin Raul Ossami Saidy; Muenevver Demir; Pauline Nibbe; Eva‐Maria Dobrindt; Robert Oellinger; Wenzel Schoening; Johann Pratschke; Dennis Eurich. 2020. "Self‐limited HBV infection of the recipient does not reactivate after liver transplantation: Observations from a 30‐year liver transplant program." Transplant Infectious Disease 23, no. 1: 1.

Journal article
Published: 23 July 2020 in Journal of Clinical Medicine
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Human cytomegalovirus (CMV) remains a major cause of mortality and morbidity in human liver transplant recipients. Anti-CMV therapeutics can be used to prevent or treat CMV in liver transplant recipients, but their toxicity needs to be balanced against the benefits. The choice of prevention strategy (prophylaxis or preemptive treatment) depends on the donor/recipient sero-status but may vary between institutions. We conducted a series of consultations and roundtable discussions with German liver transplant center representatives. Based on 20 out of 22 centers, we herein summarize the current approaches to CMV prevention and treatment in the context of liver transplantation in Germany. In 90% of centers, transient prophylaxis with ganciclovir or valganciclovir was standard of care in high-risk (donor CMV positive, recipient CMV naive) settings, while preemptive therapy (based on CMV viremia detected during (bi) weekly PCR testing for circulating CMV-DNA) was preferred in moderate- and low-risk settings. Duration of prophylaxis or intense surveillance was 3–6 months. In the case of CMV infection, immunosuppression was adapted. In most centers, antiviral treatment was initiated based on PCR results (median threshold value of 1000 copies/mL) with or without symptoms. Therefore, German transplant centers report similar approaches to the prevention and management of CMV infection in liver transplantation.

ACS Style

Cornelius Engelmann; Martina Sterneck; Karl Heinz Weiss; Silke Templin; Steffen Zopf; Gerald Denk; Dennis Eurich; Johann Pratschke; Johannes Weiss; Felix Braun; Martin-Walter Welker; Tim Zimmermann; Petra Knipper; Dirk Nierhoff; Thomas Lorf; Elmar Jäckel; Hans-Michael Hau; Tung Yu Tsui; Aristoteles Perrakis; Hans-Jürgen Schlitt; Kerstin Herzer; Frank Tacke. Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers. Journal of Clinical Medicine 2020, 9, 2352 .

AMA Style

Cornelius Engelmann, Martina Sterneck, Karl Heinz Weiss, Silke Templin, Steffen Zopf, Gerald Denk, Dennis Eurich, Johann Pratschke, Johannes Weiss, Felix Braun, Martin-Walter Welker, Tim Zimmermann, Petra Knipper, Dirk Nierhoff, Thomas Lorf, Elmar Jäckel, Hans-Michael Hau, Tung Yu Tsui, Aristoteles Perrakis, Hans-Jürgen Schlitt, Kerstin Herzer, Frank Tacke. Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers. Journal of Clinical Medicine. 2020; 9 (8):2352.

Chicago/Turabian Style

Cornelius Engelmann; Martina Sterneck; Karl Heinz Weiss; Silke Templin; Steffen Zopf; Gerald Denk; Dennis Eurich; Johann Pratschke; Johannes Weiss; Felix Braun; Martin-Walter Welker; Tim Zimmermann; Petra Knipper; Dirk Nierhoff; Thomas Lorf; Elmar Jäckel; Hans-Michael Hau; Tung Yu Tsui; Aristoteles Perrakis; Hans-Jürgen Schlitt; Kerstin Herzer; Frank Tacke. 2020. "Prevention and Management of CMV Infections after Liver Transplantation: Current Practice in German Transplant Centers." Journal of Clinical Medicine 9, no. 8: 2352.

Original report
Published: 09 June 2020 in Transplant Infectious Disease
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Background Immunosuppressed liver transplant (LT) patients are considered to be at high risk for any kind of infection. What the outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) means for the transplant cohort is a question that, as of now, cannot easily be answered. Data on prevalence, relevance of the novel virus, and clinical course of the infection in stable LT patients are limited. Methods Nasopharyngeal swabs were performed in our outpatient department during the shutdown between March and April 2020 in Germany. Results The prevalence of SARS‐CoV‐2 was 3%. Three out of a cohort of 101 LT patients were asymptomatic for respiratory diseases. Respiratory complaints were common and not associated with SARS‐CoV‐2 infection. The overall monthly mortality rate was 0.22% and did not show alterations during the shutdown in Germany. Conclusions If preventive measures are applied, LT patients do not seem to be at a higher risk for SARS‐CoV‐2 infection. Telemedicine in the outpatient setting may help to maintain distance and to reduce direct patient contact. However, standard of care must be guaranteed for patients with relevant comorbidities in spite of pandemics, because complications may arise from preexisting conditions.

ACS Style

Ramin Raul Ossami Saidy; Brigitta Globke; Johann Pratschke; Wenzel Schoening; Dennis Eurich. Successful implementation of preventive measures leads to low relevance of SARS‐CoV‐2 in liver transplant patients: Observations from a German outpatient department. Transplant Infectious Disease 2020, 22, 1 .

AMA Style

Ramin Raul Ossami Saidy, Brigitta Globke, Johann Pratschke, Wenzel Schoening, Dennis Eurich. Successful implementation of preventive measures leads to low relevance of SARS‐CoV‐2 in liver transplant patients: Observations from a German outpatient department. Transplant Infectious Disease. 2020; 22 (6):1.

Chicago/Turabian Style

Ramin Raul Ossami Saidy; Brigitta Globke; Johann Pratschke; Wenzel Schoening; Dennis Eurich. 2020. "Successful implementation of preventive measures leads to low relevance of SARS‐CoV‐2 in liver transplant patients: Observations from a German outpatient department." Transplant Infectious Disease 22, no. 6: 1.

Journal article
Published: 01 July 2018 in Transplantation
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For various reasons, liver transplant recipients are frequently affected by pleural effusions in the immediate postoperative phase. High volume turn over and low serum albumin/protein due to reduced synthesis represent main risk factors. In addition, local irritation at the diaphragm leads towards fluid collection in the right hemi-thorax. The purpose of this study was to evaluate the prevalence of drainage requiring pleural effusions after liver transplantation (LTx) and to analyze post interventional complications. The years 2009 to 2016 were analyzed retrospectively for all patients, who underwent LTx. Pediatric recipients and combined liver/lung transplantations were excluded. The indication for pleural drainage was oxygenation problems or in case of atelectasis pneumonia prophylaxis. The observation period ended at postoperative day 10. In the transplantation center Charité – Berlin 688 liver transplantations were performed in the investigated era. 375 out of 576 patients (62%) had at least one pleural drainage placed within the first 10 days after transplantation. Patients with a MELD score >20 were mostly affected (76% vs 54%, p Conclusion Pleural effusion, more frequent in patients with higher MELD, is a common complication after LTx requiring intervention in most cases. Routinely placed intraoperative chest tubes may reduce complications and avoid unnecessary coagulation products in high risk patients.

ACS Style

Leke Wiering; Paul Ritschl; Felix Sponholz; Andreas Brandl; Felix Aigner; Matthias Biebl; Dennis Eurich; Moritz Schmelzle; Igor Sauer; Katja Kotsch; Johann Pratschke; Robert Öllinger. Preemptive Chest Tube in Liver Transplantation – An Unconventional way to Reduce Morbidity. Transplantation 2018, 102, S862 .

AMA Style

Leke Wiering, Paul Ritschl, Felix Sponholz, Andreas Brandl, Felix Aigner, Matthias Biebl, Dennis Eurich, Moritz Schmelzle, Igor Sauer, Katja Kotsch, Johann Pratschke, Robert Öllinger. Preemptive Chest Tube in Liver Transplantation – An Unconventional way to Reduce Morbidity. Transplantation. 2018; 102 (Supplement):S862.

Chicago/Turabian Style

Leke Wiering; Paul Ritschl; Felix Sponholz; Andreas Brandl; Felix Aigner; Matthias Biebl; Dennis Eurich; Moritz Schmelzle; Igor Sauer; Katja Kotsch; Johann Pratschke; Robert Öllinger. 2018. "Preemptive Chest Tube in Liver Transplantation – An Unconventional way to Reduce Morbidity." Transplantation 102, no. Supplement: S862.

Article
Published: 01 July 2018 in Transplantation
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Introduction The development of hepatitis-B is considered as a serious complication after liver transplantation. It may cause severe graft dysfunction and even lead to graft loss and to patient´s death. HBV-de novo infection is a rather rare phenomenon, however it deserves attention in the era of donor organ shortage. The aim of the present analysis was to examine the course of HBV-infection in liver transplant patients without HBV-associated liver disease pretransplant including long term histological follow-up. Patients and Methods Since 1988 3005 liver transplantations have been performed at Charité, Campus Virchow-Klinikum for various liver diseases. Prevalence of patients with de novo HBV-infection transplanted for other reasons than HBV-associated liver disease was determined in a local transplant data base. Recipients of antiHbc-positive organs were excluded from the analysis. The analysis focused on the moment of HBV-detection and on the long term follow-up in terms of biochemical and histological changes during almost 30 years in a high volume transplant center in Germany. Statistical analysis was performed using SPSS version 24. Results 39 patients were identified with the diagnosis of de novo hepatitis-B (1.3%). None of the patients was transplanted because of HBV-associated liver disease, so that HBV-reinfection was ruled out. Furthermore none of them received an antiHbc-positive organ. Median time from liver transplantation to the diagnosis was 366 (8-5497) days. No fibrosis progression could be detected. Furthermore, steatosis and the grade of inflammation did not significantly change between the time of HBV-infection and the end of histological follow-up for 2897 (106-8045) days in median. Patients with a poor virological control especially in the beginning of the 90ies era before NUCs or low genetic barrier NUCs demonstrated a significantly decreased survival and 1 HBV-associated graft loss. Conclusion Since the introduction of NUCs with high genetic barrier HBV-associated graft infection is a condition that can be controlled very well without significant fibrosis progression, graft loss or patient death if recognized on time within a regular transplant follow-up schedule.

ACS Style

Christine Hofer; Eva Maria Teegen; Jasper Feldkamp; Johann Pratschke; Dennis Eurich. Results from a Long Term Histological Follow up of De Novo HBV-infection in Liver Transplant Patients Unrelated to HBV-Reinfection and HBV-Reactivation. Transplantation 2018, 102, S910 .

AMA Style

Christine Hofer, Eva Maria Teegen, Jasper Feldkamp, Johann Pratschke, Dennis Eurich. Results from a Long Term Histological Follow up of De Novo HBV-infection in Liver Transplant Patients Unrelated to HBV-Reinfection and HBV-Reactivation. Transplantation. 2018; 102 (Supplement):S910.

Chicago/Turabian Style

Christine Hofer; Eva Maria Teegen; Jasper Feldkamp; Johann Pratschke; Dennis Eurich. 2018. "Results from a Long Term Histological Follow up of De Novo HBV-infection in Liver Transplant Patients Unrelated to HBV-Reinfection and HBV-Reactivation." Transplantation 102, no. Supplement: S910.

Journal article
Published: 01 July 2018 in Transplantation
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Currently liver allocation is based on urgency in many countries, mostly represented by the MELD score. In contrast to allocation of other organs, e.g. lung, survival benefit is not included and to date no applicable outcome predictors have been implemented for liver allocation. Aim of this study was to analyze the prognostic value of hospitalization prior transplantation (Tx), pre-operative life support and the duration thereof for transplant outcome. The electronic record system of the Charité - Berlin, Germany, was analyzed retrospectively for all patients who underwent liver Tx from 2005 to 2016 for hospitalization and life support before Tx. Life support was defined as dialysis accordingly to ET Liver Allocation system, mechanical ventilation and need of catecholamines. From 1244 liver transplant recipients in this era, 264 underwent Tx coming from an intensive care unit (ICU), 178 patients from a regular ward and 802 from home. Of all recipients 187 required dialysis, 123 ventilation and 101 were under catecholamine therapy. Patients coming from the ICU were significantly younger but sicker according to their higher labMELD at day of Tx. Not surprisingly these patients had a significant lower 3 months, 1 year and 3 year survival compared to patients coming from home (ICU vs. home; 76,9% vs. 94,4% and 65,9% vs. 87,5% and 64,4% vs. 82,4%; all p=0,000). Interestingly differences between patients from the ICU and a regular ward showed no significance, not even for short term survival (3 month: 76,9% vs. 84,3%; p=0,057), decreased over time and did not have an influence on 1- and 3 year survival (1 year: 65,9% vs. 71,9%; p=0,132; 3 year: 64,4% vs. 65,2%; p=0,556). Subgroup analysis revealed that the length of ICU stay prior to Tx had a significant impact on patient survival if longer than 6 days (1-6 days vs. 7-14 days; 1 year p=0,036). Remarkably no changes between 7-14 days or >14 days could be noticed (p=0,469). Dialysis prior to Tx was associated with an inferior outcome compared to patients without renal placement (3 year: 56,1% vs. 79,7% p=0,000). These results remained significant even for patients receiving only dialysis and no other life support therapy whereas ventilation or catecholamines alone did not influence survival. There were no significant differences between the pre-operative labMELD of these three groups. However, recipients with ventilation and catecholamines showed similar results as patient with dialysis only (3 year: 61,3% vs. 60,6% p=0,890). Patients with the triad of dialysis, ventilation and vasopressor therapy had the worst outcome with a 3 year patient survival of only 47,4% compared to 80% of patients without life support (p=0,000). Hospitalization status as well as life support before Tx are valuable predictors for patient survival following liver Tx and should be considered for the allocation process.

ACS Style

Leke Wiering; Paul Ritschl; Michael Hippler-Benscheidt; Felix Aigner; Matthias Biebl; Dennis Eurich; Moritz Schmelzle; Igor Sauer; Katja Kotsch; Johann Pratschke; Robert Öllinger. Hospitalization and Life Support before Liver Transplantation – Easily available Predictors for Post-Transplant Patient Survival. Transplantation 2018, 102, S273 .

AMA Style

Leke Wiering, Paul Ritschl, Michael Hippler-Benscheidt, Felix Aigner, Matthias Biebl, Dennis Eurich, Moritz Schmelzle, Igor Sauer, Katja Kotsch, Johann Pratschke, Robert Öllinger. Hospitalization and Life Support before Liver Transplantation – Easily available Predictors for Post-Transplant Patient Survival. Transplantation. 2018; 102 (Supplement):S273.

Chicago/Turabian Style

Leke Wiering; Paul Ritschl; Michael Hippler-Benscheidt; Felix Aigner; Matthias Biebl; Dennis Eurich; Moritz Schmelzle; Igor Sauer; Katja Kotsch; Johann Pratschke; Robert Öllinger. 2018. "Hospitalization and Life Support before Liver Transplantation – Easily available Predictors for Post-Transplant Patient Survival." Transplantation 102, no. Supplement: S273.

Article
Published: 01 July 2018 in Transplantation
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The MELD-based allocation system has been implemented in Germany in 2006 in order to decrease waiting list mortality in patients with end stage liver disease. However, the MELD score not only reflects the probability to die within 3 months, but simultaneously represents a major risk factor for post transplantation patient survival. Purpose of this study is to evaluate post transplant results and waiting list mortality since the introduction of MELD-based allocation. Liver transplant patients were assessed retrospectively from 2005 -2015 using our own center as well as open access Eurotransplant data. In our department 1172 liver transplantations were performed from 2005 to 2015. The median Match-MELD at time of transplantation increased from 16 to 26 (Pearson r=0.69, p= 0.019). Concomitantly, 3-year patient survival decreased from 85% in 2005 to 70% in 2012 (Pearson r=-0.78, p= 0.022). Similarly, in the Eurotransplant area the average 3-year patient survival decreased from 78% to 70%. In these years on average 57 percent of all liver transplantations were performed in Germany. During this time period donor age increased from 48 to 54 to overcome organ shortage. Simultaneously the number of transplantations per year dramatically decreased from 158 in 2005 to 79 in 2015 at our center. At the same time the ratio of waiting list mortality/active-listed patients increased significantly from 2007 to 2016 (Pearson r=0.69, p= 0.019), indicating an increased waiting list mortality. The combination of increasing organ scarcity and MELD based allocation may require reconsideration of the current allocation policy and the inclusion of prognostic outcome factors should be discussed.

ACS Style

Paul Ritschl; Leke Wiering; Michael Hippler-Benscheidt; Felix Aigner; Matthias Biebl; Dennis Eurich; Moritz Schmelzle; Igor Sauer; Katja Kotsch; Johann Pratschke; Robert Öllinger. MELD based Allocation Deteriorates Patient Survival without Improving Waiting List Mortality in a Low Donor Area. Transplantation 2018, 102, S275 .

AMA Style

Paul Ritschl, Leke Wiering, Michael Hippler-Benscheidt, Felix Aigner, Matthias Biebl, Dennis Eurich, Moritz Schmelzle, Igor Sauer, Katja Kotsch, Johann Pratschke, Robert Öllinger. MELD based Allocation Deteriorates Patient Survival without Improving Waiting List Mortality in a Low Donor Area. Transplantation. 2018; 102 (Supplement):S275.

Chicago/Turabian Style

Paul Ritschl; Leke Wiering; Michael Hippler-Benscheidt; Felix Aigner; Matthias Biebl; Dennis Eurich; Moritz Schmelzle; Igor Sauer; Katja Kotsch; Johann Pratschke; Robert Öllinger. 2018. "MELD based Allocation Deteriorates Patient Survival without Improving Waiting List Mortality in a Low Donor Area." Transplantation 102, no. Supplement: S275.

Article
Published: 01 July 2018 in Transplantation
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Introduction Hepatitis-B-(HBV)-associated end stage liver disease has been one of the main indication for liver transplantation (LT) for the last decades. After LT, a HBV-reinfection remains as a serious issue and preventing strategies range from the sole application of hepatitis-B immunoglobulins (HBIG) during the anhepatic phase, to modern nucleotide analogues in combination with HBIG and later HBIG-discontinuation. The aim of the analysis was to evaluate different prophylaxis strategies and to sum up the results of 30 years at a high volume transplant center. Patients and Methods We performed 372 liver transplantations due to a HBV-associated liver disease at our clinic sinca 1988. Demographic, clinical, biochemical and histological data was extracted from a prospectively organized data base. The median follow up was 13 years. We evaluated indication for transplantation, serological status and age at time of transplantation, type of prophylaxis, stage of fribosis at 1, 3, 5, 7, 10 and 13 years after LT. The incidence and time of HBV-reinfection were investigated and analyzed. Primary endpoint was the survival depending on the type of prophylaxis. Results Among 372 LTs we identified 109 (29.3%) HBV-reinfections. HBV-reinfections after LT were significantly more frequent in male patients (84.4% vs. 73.4% in the group of with no reinfections, p=0.022). Furthermore, patients with an acute liver failure due to HBV-infection (11.0% vs. 2.8%, p=0.028) were at a significantly lower risk for a reinfection after LT as well as patients with a HCV-coinfection (11.4% vs. 4.6%, p=0.047). No significant differences in the distribution of HBV-reinfection could be observed regarding the presence of HCC (24.7 vs. 30.1; p=0.388) and HDV-co-infection (23.3 vs. 29.8%; p=0.474). Re-transplantation was not a significant risk factor for a reinfection, but the HBV-associated graft loss was significantly higher in the group of patients with a HBV-reinfection (7.3% vs. 1.9%, p=0.000). Patients with HBV-reinfection demonstrated a significantly poorer survival than patients without reinfection (log rank; p=0.004). Controlled HBV-reinfection did not demonstrated any fibrosis progression during a median histological follow-up of 13 years. Reinfection did not significantly influence the survival in patients who received NUCs and HBIG (log rank; p=0.233) compared to patients who received HBIG or nothing at all as HBV-prophylaxis (log rank; p=0.004). HBIG-discontinuation was initiated in 67 patients with just 1 patient with HBV-recurrence. Conclusion Female gender, acute liver failure for transplant indication as well as a HCV-coinfection had a lower risk for HBV-reinfection. Hbs-Ag –positive grafts did not develop fibrosis during a long-term follow up. The most reliable mode to prevent HBV-recurrence is still the combination of NUCs with a high genetic barrier and HBIG. HBIG can safely be discontinued after a still undetermined period of time after liver transplantation.

ACS Style

Eva Teegen; Julius Plewe; Antje Butter; Brigitta Globke; Johann Pratschke; Dennis Eurich. Treatment of HBV-Recurrence After Liver Transplantation – 30 Years of Experience. Transplantation 2018, 102, S55 .

AMA Style

Eva Teegen, Julius Plewe, Antje Butter, Brigitta Globke, Johann Pratschke, Dennis Eurich. Treatment of HBV-Recurrence After Liver Transplantation – 30 Years of Experience. Transplantation. 2018; 102 (Supplement):S55.

Chicago/Turabian Style

Eva Teegen; Julius Plewe; Antje Butter; Brigitta Globke; Johann Pratschke; Dennis Eurich. 2018. "Treatment of HBV-Recurrence After Liver Transplantation – 30 Years of Experience." Transplantation 102, no. Supplement: S55.

Comparative study
Published: 11 January 2017 in Transplant Infectious Disease
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Hepatitis C virus (HCV) recurrence after liver transplantation (LT) used to be a serious problem in the era of interferon-based treatment. Since the introduction of modern directly acting antivirals, treatment has become easier and shorter. According to published data, in the natural course of hepatitis C infection the duration of antiviral treatment with sofosbuvir (SOF) and ledipasvir (LDV) may be shortened to 12 instead of 24 weeks, using ribavirin (RBV) in addition. Furthermore, the question of whether or not RBV is really necessary, in a 12-week SOF/LDV treatment in the post-transplant setting, is still unanswered. At our institution, 100 liver transplant patients with HCV recurrence underwent interferon-free SOF-based treatment. A total of 51 patients received SOF/LDV with or without RBV. Twenty-nine HCV genotype 1 or 4 patients with histologically proven stage 0-2 fibrosis were treated with SOF/LDV for 12 weeks; another 22 patients with advanced fibrosis (stage 3-4) either received SOF/LDV plus weight-adjusted RBV or prolonged treatment for 24 weeks. End of treatment response and sustained virological response (SVR) were achieved in 100% of the 51 patients, irrespective of the treatment group. Patients with prolonged treatment duration or with RBV developed significantly more adverse events (AEs) compared to the SOF/LDV group: 19 (86.4%) vs 8 (27.6%), P<.001. One of the predominant and most relevant AEs was the development of anemia in 43.1% of 10 patients receiving RBV, which was a significant result (P<.001). RBV co-medication had to be reduced in 11 (55%) patients and then stopped in 8 (40%) patients because of AEs. No significant difference was observed among the groups regarding kidney function. The SOF/LDV combination is a reliable therapy of recurrent HCV infection after LT. It is easy to administer and to achieve SVR in immunocompromised patients without interactions with immunosuppressive medications. Considering the high rate of AEs, frequent discontinuation of RBV treatment, and the 100% SVR, the use of RBV as co-medication in a 12-week SOF/LDV regimen does not seem to be justified after LT.

ACS Style

Brigitta Globke; Eckart Schott; Nathanael Raschzok; Eva-Maria Teegen; Johann Pratschke; Dennis Eurich. Treatment of hepatitis C virus recurrence after transplantation with sofosbuvir/ledipasvir: The role of ribavirin. Transplant Infectious Disease 2017, 19, e12647 .

AMA Style

Brigitta Globke, Eckart Schott, Nathanael Raschzok, Eva-Maria Teegen, Johann Pratschke, Dennis Eurich. Treatment of hepatitis C virus recurrence after transplantation with sofosbuvir/ledipasvir: The role of ribavirin. Transplant Infectious Disease. 2017; 19 (1):e12647.

Chicago/Turabian Style

Brigitta Globke; Eckart Schott; Nathanael Raschzok; Eva-Maria Teegen; Johann Pratschke; Dennis Eurich. 2017. "Treatment of hepatitis C virus recurrence after transplantation with sofosbuvir/ledipasvir: The role of ribavirin." Transplant Infectious Disease 19, no. 1: e12647.

Original article
Published: 27 September 2016 in Updates in Surgery
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Biliary leakage is a serious complication after liver resection and represents the major cause of post-operative morbidity. In spite of already identified risk factors, little is known about the role of intra-biliary pressure following liver surgery in the development of biliary leakage. Biliary decompression may have a positive impact and reduce the incidence of biliary leakage at the parenchymal resection site. 397 patients undergoing liver resection without bilioenteric anastomosis were included in the retrospective analysis of the risk factors for the development of biliary leakage focusing on the intra-operative reduction of the biliary pressure by T-tube and liver histology. Among 397 analyzed patients after parenchymal resection, biliary leakage occurred in 39 cases (9.8 %). The extent of parenchymal resection was not associated with the total occurrence of biliary leak (p = 0.626). Lower incidence of biliary leakage from the resection surface was significantly associated with the use of T-tube (4.9 vs. 13.2 %; p = 0.006). In the subgroup analysis, insertion of a T-tube was not associated with a reduction of biliary leakage after anatomical hemihepatectomies (p = 0.103) and extraanatomical liver resection (p = 0.676). However, a high statistical significance could be detected in patients with extended hemihepatectomies (58.3 vs. 3.8 %; p < 0.001). Once biliary leak occurred without T-tube, median hospitalization duration significantly increased compared to patients with biliary decompression and without biliary leak (p < 0.001). The results of our retrospective data analysis suggest a significant beneficial impact of the T-tube on the development of biliary leakage in patients undergoing extended liver surgery.

ACS Style

Dennis Eurich; S. Henze; S. Boas-Knoop; J. Pratschke; D. Seehofer. T-drain reduces the incidence of biliary leakage after liver resection. Updates in Surgery 2016, 68, 369 -376.

AMA Style

Dennis Eurich, S. Henze, S. Boas-Knoop, J. Pratschke, D. Seehofer. T-drain reduces the incidence of biliary leakage after liver resection. Updates in Surgery. 2016; 68 (4):369-376.

Chicago/Turabian Style

Dennis Eurich; S. Henze; S. Boas-Knoop; J. Pratschke; D. Seehofer. 2016. "T-drain reduces the incidence of biliary leakage after liver resection." Updates in Surgery 68, no. 4: 369-376.

Journal article
Published: 15 January 2013 in Transplantation
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Hepatitis C virus (HCV) reinfection after liver transplantation may lead to recirrhosis and seems to be influenced by genetic factors. The aim of our study was to evaluate the role of STAT-4-polymorphisms in the development of HCV-related graft disease based on protocol biopsies. One hundred sixty transplant patients with HCV recurrence were genotyped for STAT-4 (rs7574865) by polymerase chain reaction. Fibrosis stages were determined based on Desmet and Scheuer classification. SPSS was used for the statistical analysis of genotype distribution and of time to the development of advanced fibrosis among the genotypes. During a comparable observation period of 86.2 months (P=0.654), 65 patients (46.5%) developed advanced fibrosis. Advanced fibrosis was observed significantly more frequent in patients (n=34) with at least one T-allele (53.1 vs. 32.3%; P=0.013) compared with homozygotes for G-allele (n=31). Significant differences in the duration of advanced fibrosis development were detected between patients with at least one T-allele compared with G-allele (34.4 vs. 49.0 months; P=0.022). No impact was observed regarding the outcome of interferon-based antiviral treatment (P=0.297) and the occurrence of acute cellular rejection (P=0.365). Present results indicate a possible impact of genetic confounders in the recipient on graft fibrogenesis, thus explaining significantly different graft behavior observed after transplantation for HCV-associated liver disease. STAT-4-T-allele is identified as fibrogenic factor and seems to have a negative impact on HCV-induced fibrosis development.

ACS Style

Dennis Eurich; Sabine Boas-Knoop; Benjamin Struecker; Ruth Neuhaus; Peter Neuhaus; Marcus Bahra. Genetic Variants of STAT-4 Affect the Development of Graft Fibrosis After Liver Transplantation for HCV-Induced Liver Disease. Transplantation 2013, 95, 203 -208.

AMA Style

Dennis Eurich, Sabine Boas-Knoop, Benjamin Struecker, Ruth Neuhaus, Peter Neuhaus, Marcus Bahra. Genetic Variants of STAT-4 Affect the Development of Graft Fibrosis After Liver Transplantation for HCV-Induced Liver Disease. Transplantation. 2013; 95 (1):203-208.

Chicago/Turabian Style

Dennis Eurich; Sabine Boas-Knoop; Benjamin Struecker; Ruth Neuhaus; Peter Neuhaus; Marcus Bahra. 2013. "Genetic Variants of STAT-4 Affect the Development of Graft Fibrosis After Liver Transplantation for HCV-Induced Liver Disease." Transplantation 95, no. 1: 203-208.

Journal article
Published: 19 December 2012 in Journal of Gastroenterology and Hepatology
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Worldwide anti‐tuberculosis (TB) drug‐induced liver disease (DILI) is an important cause of hepatotoxicity, and drug‐induced acute liver failure (ALF). Reported series on anti‐TB DILI are limited by a mix of cases with mild transaminase elevation or adaptation. Our aim was to analyze the clinical features, laboratory characteristics, outcome, and determine predictors of 90‐day mortality. Single center analysis of consecutive cases of anti‐TB DILI following combination anti‐TB drugs exposure from 1997–2011. Of the 269 patients, 191 (71%) experienced jaundice and 69 (25.7%) accounted for ALF. The mean age and treatment duration was 41.3 years and 1.9 months, respectively; males constituted 55.7%. DILI occurred throughout the course of treatment; three‐quarters occurred within the first 2 months. HIV infection was present in 21 (7.8%). The 90‐day mortality was 22.7%. DILI accompanied by jaundice (n = 191), encephalopathy (n = 69) or ascites (n = 69) resulted in mortality in 30%, 69.6% and 50.7%, respectively (P < 0.001). Age, gender, transaminase levels, HIV or hepatitis B surface antigen (HBsAg) status did not influence survival. Treatment duration, encephalopathy, ascites, bilirubin, serum albumin, international normalized ratio (INR), serum creatinine and leukocyte count were associated with mortality (P < 0.001). Multivariate logistic regression model for mortality, incorporating encephalopathy, albumin, bilirubin, INR, and creatinine yielded a C‐statistic of 97%. Anti‐TB DILI occurs throughout treatment duration progressing to ALF in a quarter of patients. The overall mortality is 22.7%, which is higher when accompanied by jaundice, ascites or encephalopathy. An anti‐TB DILI model, incorporating bilirubin, INR, encephalopathy, serum creatinine and albumin predicted mortality with C‐statistic of 97%.

ACS Style

Harshad Devarbhavi; Rajvir Singh; Mallikarjun Patil; Keyur Sheth; Channagiri Krishnamurthy Adarsh; Girisha Balaraju. Outcome and determinants of mortality in 269 patients with combination anti-tuberculosis drug-induced liver injury. Journal of Gastroenterology and Hepatology 2012, 28, 161 -167.

AMA Style

Harshad Devarbhavi, Rajvir Singh, Mallikarjun Patil, Keyur Sheth, Channagiri Krishnamurthy Adarsh, Girisha Balaraju. Outcome and determinants of mortality in 269 patients with combination anti-tuberculosis drug-induced liver injury. Journal of Gastroenterology and Hepatology. 2012; 28 (1):161-167.

Chicago/Turabian Style

Harshad Devarbhavi; Rajvir Singh; Mallikarjun Patil; Keyur Sheth; Channagiri Krishnamurthy Adarsh; Girisha Balaraju. 2012. "Outcome and determinants of mortality in 269 patients with combination anti-tuberculosis drug-induced liver injury." Journal of Gastroenterology and Hepatology 28, no. 1: 161-167.

Hepatology
Published: 18 September 2012 in Journal of Gastroenterology and Hepatology
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Background and Aim The development of end‐stage graft disease is suspected to be partially determined by an individual genetic background. The aim of our study was to determine the prevalence of YKL‐40‐gene polymorphism in hepatitis C virus (HCV)‐positive patients and its impact on the incidence of acute cellular rejection (ACR), graft fibrosis and antiviral treatment response. Methods A total of 149 patients, who underwent liver transplantation for HCV‐induced liver disease, were genotyped for YKL‐40 (rs4950928; G/C) by TaqMan Genotyping Assay. The results were correlated with 616 post‐transplant graft biopsies regarding inflammation, fibrosis and evidence for ACR. Results No association of YKL‐40‐gemotypes was observed regarding mean inflammation grade (P = 0.216) and antiviral treatment outcome (P = 0.733). However, the development of advanced fibrosis (F3‐4) was significantly faster in patients with YKL‐40‐G‐allele: t(CC) = 4.6 versus t(CG/GG) = 2.4 years; P = 0.006. Patients with lower fibrosis (F0‐2) compared to advanced fibrosis (F3‐4) received significantly more frequent dual immunosuppression (calcineurin inhibitors [CNIs]/mofetile mycophenolate [MMF] vs CNIs; P = 0.003). ACR‐occurrence was associated with YKL‐40‐genotypes (ACR: CC = 60.4%, CG = 25.0% and GG = 14.6% vs non‐ACR: CC = 74.2%, CG = 23.8% and GG = 2.0%; P = 0.009) and with gender compatibility between donor and recipient (P = 0.012). Conclusion Fibrosis progression and ACR‐incidence after transplantation for HCV‐induced liver disease seem to be under genetic control. The negative impact of G‐allele on post‐transplant events observed in our study, deserves attention and should be verified in larger liver transplantation‐cohorts.

ACS Style

Dennis Eurich; Ulf P Neumann; Sabine Boas-Knoop; Ruth Neuhaus; Anja Kiessling; Ali Yahyazadeh; Christian Trautwein; Hermann Wasmuth; Gero Puhl; Peter Neuhaus; Marcus Bahra. YKL-40-gene polymorphism affects acute cellular rejection and fibrosis progression after transplantation for hepatitis C virus-induced liver disease. Journal of Gastroenterology and Hepatology 2012, 28, 153 -160.

AMA Style

Dennis Eurich, Ulf P Neumann, Sabine Boas-Knoop, Ruth Neuhaus, Anja Kiessling, Ali Yahyazadeh, Christian Trautwein, Hermann Wasmuth, Gero Puhl, Peter Neuhaus, Marcus Bahra. YKL-40-gene polymorphism affects acute cellular rejection and fibrosis progression after transplantation for hepatitis C virus-induced liver disease. Journal of Gastroenterology and Hepatology. 2012; 28 (1):153-160.

Chicago/Turabian Style

Dennis Eurich; Ulf P Neumann; Sabine Boas-Knoop; Ruth Neuhaus; Anja Kiessling; Ali Yahyazadeh; Christian Trautwein; Hermann Wasmuth; Gero Puhl; Peter Neuhaus; Marcus Bahra. 2012. "YKL-40-gene polymorphism affects acute cellular rejection and fibrosis progression after transplantation for hepatitis C virus-induced liver disease." Journal of Gastroenterology and Hepatology 28, no. 1: 153-160.