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Charité-Universitätsmedizin Berlin, Department of Surgery, Charitéplatz 1, 10117 Berlin
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.
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 StyleMarius 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 StyleMarius 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.
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.
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 StyleRamin 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 StyleRamin 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.
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.
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 StyleRamin 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 StyleRamin 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.
Insulinomas are rare, benign and functional tumors that coincidentally may become overt during pregnancy or in the post-partum period. As the general symptoms of a pregnancy might cover the clinical presentation, diagnosing remains challenging. We present one additional case of a post-partum insulinoma, combined with a systematic review of the literature to sum up relevant details in diagnosis and treatment. A systematic request of Pubmed/Medline was conducted using the following terms: “insulinoma AND pregnancy” and “insulinoma” for a second request of ClinicalTrials.gov. All publications concerning pregnant or post-partum women with insulinoma were included. Thirty-six cases could be identified for analysis. Each publication was reviewed for demographic, diagnostic and therapeutic data. The most frequent clinical signs were unconsciousness and neurological symptoms. 64.9% were diagnosed during early pregnancy and 35.1% post-partum. 91.9% underwent surgery with a third resected during pregnancy without severe influence on fetal or maternal outcome. Three patients died of metastatic disease or misdiagnosing, two of them miscarried. Insulinoma in pregnancy is rare but should be considered in case of unclear hyperinsulinemic hypoglycemia. Surgery can be performed during the second trimester or post-partum with promising outcome.
Eva M Dobrindt; Martina Mogl; Peter E Goretzki; Johann Pratschke; Agata K Dukaczewska. Insulinoma in pregnancy (a case presentation and systematic review of the literature). Rare Tumors 2021, 13, 1 .
AMA StyleEva M Dobrindt, Martina Mogl, Peter E Goretzki, Johann Pratschke, Agata K Dukaczewska. Insulinoma in pregnancy (a case presentation and systematic review of the literature). Rare Tumors. 2021; 13 ():1.
Chicago/Turabian StyleEva M Dobrindt; Martina Mogl; Peter E Goretzki; Johann Pratschke; Agata K Dukaczewska. 2021. "Insulinoma in pregnancy (a case presentation and systematic review of the literature)." Rare Tumors 13, no. : 1.
Eva Maria Dobrindt; Dennis Eurich; Wilfried Veltzke-Schlieker; Johann Pratschke; Igor Sauer; Robert Öllinger; Rosa Bianca Schmuck. Ischemic-Type Biliary Lesions After Liver Transplant: Factors Causing Early-Onset Versus Late-Onset Disease. Experimental and Clinical Transplantation 2020, 18, 591 -597.
AMA StyleEva Maria Dobrindt, Dennis Eurich, Wilfried Veltzke-Schlieker, Johann Pratschke, Igor Sauer, Robert Öllinger, Rosa Bianca Schmuck. Ischemic-Type Biliary Lesions After Liver Transplant: Factors Causing Early-Onset Versus Late-Onset Disease. Experimental and Clinical Transplantation. 2020; 18 (5):591-597.
Chicago/Turabian StyleEva Maria Dobrindt; Dennis Eurich; Wilfried Veltzke-Schlieker; Johann Pratschke; Igor Sauer; Robert Öllinger; Rosa Bianca Schmuck. 2020. "Ischemic-Type Biliary Lesions After Liver Transplant: Factors Causing Early-Onset Versus Late-Onset Disease." Experimental and Clinical Transplantation 18, no. 5: 591-597.
Background Nonalcoholic steatohepatitis has become one of the leading causes of liver transplantation. The development of steatosis, as well as the link to inflammation and fibrosis, after transplantation remain poorly understood. The aim of this analysis was to evaluate the influence of obesity on histopathological changes of the graft during long‐term follow‐up. Methods A total of 1494 longitudinal liver biopsies of 271 recipients were evaluated during a follow‐up period of 5 to 10 years. Clinical and laboratory parameters as well as histopathological categories of steatosis, inflammation, and fibrosis were explored by routine protocol biopsies. Results The BMI and prevalence of diabetes mellitus significantly increased after transplantation (p<0.01). Diabetes and de novo obesity were significantly associated with the degree of graft steatosis. There was no correlation between former steatosis and inflammation or fibrosis. Inflammation was a precursor of fibrosis, and fibrosis increased over the first 3 years (p<0.01). No severe graft dysfunction was observed. Conclusion Obesity and diabetes mellitus correlated with higher grades of steatosis and de novo steatosis after transplantation. Metabolic syndrome must be considered as a serious post‐transplant complication that can cause histopathological alteration. However, the progress from steatosis to steatohepatitis is not as common as expected.
Eva M. Dobrindt; Laura Allex; Akylbek Saipbaev; Robert Öllinger; Wenzel Schöning; Johann Pratschke; Dennis Eurich. Association between obesity after liver transplantation and steatosis, inflammation, and fibrosis of the graft. Clinical Transplantation 2020, 34, 1 .
AMA StyleEva M. Dobrindt, Laura Allex, Akylbek Saipbaev, Robert Öllinger, Wenzel Schöning, Johann Pratschke, Dennis Eurich. Association between obesity after liver transplantation and steatosis, inflammation, and fibrosis of the graft. Clinical Transplantation. 2020; 34 (12):1.
Chicago/Turabian StyleEva M. Dobrindt; Laura Allex; Akylbek Saipbaev; Robert Öllinger; Wenzel Schöning; Johann Pratschke; Dennis Eurich. 2020. "Association between obesity after liver transplantation and steatosis, inflammation, and fibrosis of the graft." Clinical Transplantation 34, no. 12: 1.
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.
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 StyleRamin 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 StyleRamin 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.
A retrospective analysis of patients undergoing LT at our center between 1990 and 2016 identified 29 patients with HC. End points were the evaluation of post-LT iron reaccumulation and the stage of fibrosis as well as the degree of inflammation of the liver graft. Secondary end points were patient survival and postoperative complications. The median age was 52.7 y, and there were more male (82.8%) than female patients (17.2%). Post-LT serum ferritin values (>1000 μg/L) were only temporarily elevated in 2 patients. The median estimated survival after LT was 45.5 mo (0.1–285.9 mo). Twenty patients (69%) died during follow-up of 10 y. The survival of patients with HC was significantly worse (P = 0.001) when compared with the overall cohort of patients undergoing LT because of to other causes. There was no significant iron overload detected in patients with HC after LT, and only minimal iron deposits were described in liver biopsies. Nevertheless, patients suffering from HC show a lower post-LT survival when compared with patients without iron storage disease but mostly because of extrahepatic causes.
Eva Maria Dobrindt; Eriselda Keshi; Julian Neulichedl; Wenzel Schöning; Robert Öllinger; Johann Pratschke; Dennis Eurich. Long-term Outcome of Orthotopic Liver Transplantation in Patients With Hemochromatosis: A Summary of a 30-year Transplant Program. Transplantation Direct 2020, 6, e560 .
AMA StyleEva Maria Dobrindt, Eriselda Keshi, Julian Neulichedl, Wenzel Schöning, Robert Öllinger, Johann Pratschke, Dennis Eurich. Long-term Outcome of Orthotopic Liver Transplantation in Patients With Hemochromatosis: A Summary of a 30-year Transplant Program. Transplantation Direct. 2020; 6 (6):e560.
Chicago/Turabian StyleEva Maria Dobrindt; Eriselda Keshi; Julian Neulichedl; Wenzel Schöning; Robert Öllinger; Johann Pratschke; Dennis Eurich. 2020. "Long-term Outcome of Orthotopic Liver Transplantation in Patients With Hemochromatosis: A Summary of a 30-year Transplant Program." Transplantation Direct 6, no. 6: e560.
Timing of parathyroidectomy (PTX) remains controversial in candidates for kidney transplant with concomitant renal hyperparathyroidism (HPT). The aim of this retrospective study was to identify the influence of early vs late posttransplant PTX compared to pretransplant PTX on renal graft function and morbidity. This single-center cohort study includes 57 patients with renal HPT and kidney transplantation treated between 2007 and 2017. Ninety-six patients had surgery for renal HPT between 2007 and 2017 as a consecutive sample. Group 1 (n = 30; tertiary HPT), group 2 (n = 66; secondary HPT). Of group 1, 4 patients were excluded for PTX before and after kidney transplantation. In group 2, 20 patients were excluded since they had not undergone kidney transplantation during follow-up. Twelve patients were excluded because of short follow-up (kidney transplantation in 2018), and 3 patients were excluded because of transplant failure within 90 days. Twenty-six patients underwent posttransplant PTX (10 patients within 12 months after transplant), and 31 patients had undergone PTX prior to kidney transplantation. Graft function, serum calcium concentrations, parathyroid hormone (PTH) levels, postoperative morbidity, and 90-day mortality were recorded. Median age was 53.1 years in group 1 and 49.1 years in group 2. Most patients were male (53.8% in group 1; 54.8% in group 2). Median preoperative PTH levels were significantly different with 331.6 pg/mL in group 1 and 667.5 pg/mL in group 2 (P = .003). Creatinine levels changed little from 1.4 mg/dL (range, 0.8-2.5) to 1.7 mg/dL (range, 0.7-7.3) in group 1, and no difference was seen between early or late PTX after transplantation. In group 2, creatinine levels were 8.5 mg/dL (range, 4.6-11.7) before PTX and 8.7 mg/dL (range, 5.1-11.9) after PTX. We saw no correlation between postoperative PTH and kidney function. Thirty-five patients with postoperative PTH < 15 pg/mL displayed a mean postoperative creatinine of 5.5 mg/dL (range, 4.3-6.8), similar to other patients. Both the 30-day and 90-day mortality rates were zero. PTX had no negative effect on graft function, whether performed before or after (early or late) kidney transplantation. Surgical cure of renal HPT should be performed as soon as possible to prevent secondary complications and can also be safely carried out early after transplantation.
Claudia Bures; Philippa Seika; Tatjana Skachko; Eva Maria Dobrindt; Nada Rayes; Johann Pratschke; Peter E. Goretzki; Martina T. Mogl. Influence of Parathyroidectomy on Kidney Graft Function in Secondary and Tertiary Hyperparathyroidism. Transplantation Proceedings 2020, 52, 3134 -3143.
AMA StyleClaudia Bures, Philippa Seika, Tatjana Skachko, Eva Maria Dobrindt, Nada Rayes, Johann Pratschke, Peter E. Goretzki, Martina T. Mogl. Influence of Parathyroidectomy on Kidney Graft Function in Secondary and Tertiary Hyperparathyroidism. Transplantation Proceedings. 2020; 52 (10):3134-3143.
Chicago/Turabian StyleClaudia Bures; Philippa Seika; Tatjana Skachko; Eva Maria Dobrindt; Nada Rayes; Johann Pratschke; Peter E. Goretzki; Martina T. Mogl. 2020. "Influence of Parathyroidectomy on Kidney Graft Function in Secondary and Tertiary Hyperparathyroidism." Transplantation Proceedings 52, no. 10: 3134-3143.
Background Hepatitis B immunoglobulin (HBIG) ‐ as a monotherapy or combined with nucleos(t)ide analogs (NUCs) ‐ has effectively lowered Hepatitis B virus (HBV) reinfection after liver transplantation. However, it is associated with high costs and viral resistance. HBIG‐free prophylaxis with novel NUCs (tenofovir, entecavir) composes a viable alternative. We evaluated reinfection rate, histological changes and outcome associated with HBIG‐ discontinuation. Methods A retrospective analysis was performed of patients undergoing liver transplantation due to HBV‐induced liver disease at our center since 1988. A controlled HBIG‐discontinuation was conducted between 2015 and 2017 in 65 patients. Recurrent infection was determined by HbsAg values. Fibrosis and inflammation were evaluated by routine biopsy. The survival of patients after HBIG‐discontinuation was compared to a control population on HBIG for prophylaxis. Results From 1988 to 2013, 352 patients underwent liver transplantation due to HBV‐induced liver disease. 169 patients could be included for analysis. 104 (51.5%) patients continued a prophylaxis containing HBIG. HBIG was discontinued in 65 (38.5%) patients in a controlled manner, maintaining an oral NUC. None of those patients showed HBV‐reinfection or graft dysfunction. No significant changes of inflammation grades (p=0.067) or fibrosis stages (p=0.051) were detected. The survival of patients after HBIG‐discontinuation was comparable to the control (p=0.95). Conclusion HBIG‐withdrawal under continuation of oral NUC therapy is safe and not related to graft dysfunction, based on blood tests and histology. HBIG‐free prophylaxis is not associated with a worse outcome and displays a financial relief as well as a logistic simplification during long‐term follow‐up.
Eva Maria Dobrindt; Eriselda Keshi; Yones Salim; Allan Gillespie; Akylbek Saipbaev; Wenzel Schöning; Robert Öllinger; Johann Pratschke; Dennis Eurich. Hepatitis B Immunoglobulin discontinuation in long‐term liver transplant patients. Transplant Infectious Disease 2020, 22, e13303 .
AMA StyleEva Maria Dobrindt, Eriselda Keshi, Yones Salim, Allan Gillespie, Akylbek Saipbaev, Wenzel Schöning, Robert Öllinger, Johann Pratschke, Dennis Eurich. Hepatitis B Immunoglobulin discontinuation in long‐term liver transplant patients. Transplant Infectious Disease. 2020; 22 (4):e13303.
Chicago/Turabian StyleEva Maria Dobrindt; Eriselda Keshi; Yones Salim; Allan Gillespie; Akylbek Saipbaev; Wenzel Schöning; Robert Öllinger; Johann Pratschke; Dennis Eurich. 2020. "Hepatitis B Immunoglobulin discontinuation in long‐term liver transplant patients." Transplant Infectious Disease 22, no. 4: e13303.
Introduction Colorectal carcinomas represent the third most common cause of cancer-related deaths in Germany. Although the incidence is significantly higher in men compared with women and gender is a well-established crucial factor for outcome in other diseases, detailed gender comparisons for colon cancer are lacking. Methods This retrospective population-based cohort study included all patients diagnosed with colon cancer in Germany between 2000 and 2016 who were included in the common dataset of colorectal cancer patients from the quality conference of the German Cancer Society. We compared clinical, histopathological, and therapeutic characteristics as well as overall and recurrence-free survival. Results A total of 185,967 patients were included in the study, of which 85,685 were female (46.1%) and 100,282 were male (53.9%). The proportion of women diagnosed with colon cancer decreased from 2000 to 2016 (f: 26.6 to 40.1%; m: 24.9 to 41.9%; p < 0.001), and the proportion of very old patients was especially high in women (f: 27.3%; m: 15.6%; p < 0.001). The localization in women was more right-sided (f: 45.0%, m: 36.7%; p < 0.001), and women had a higher tumor grading and a higher UICC stage (especially stage III nodal-positive) at diagnosis of primary colon cancer (UICC III: f: 22.7%, m: 21.0%; p < 0.001). We could detect a significantly better overall (hazard ratio: 0.853, lower 95%: 0.841, upper 95%: 0.864; p < 0.001) and recurrence-free survival (hazard ratio: 0.857, lower 95%: 0.845, upper 95%: 0.868; p < 0.001) in women compared with men, even though women received chemotherapy less frequently compared with men (f: 26.1%, m: 28.1%; p < 0.001). Conclusion We could detect several variables that differed significantly between men and women regarding clinical, histopathological, therapeutic, and outcome factors. We believe that it is crucial to consider gender as a key factor in the diagnosis and treatment of colon cancer. Sex-specific diagnostic tools could lead to an earlier diagnosis of colon cancer in women, and ways to increase the rate of chemotherapy in women should be evaluated. Furthermore, we recommend stratifying randomized trials by gender.
Rosa Schmuck; Michael Gerken; Eva-Maria Teegen; Isabell Krebs; Monika Klinkhammer-Schalke; Felix Aigner; Johann Pratschke; Beate Rau; Stefan Benz. Gender comparison of clinical, histopathological, therapeutic and outcome factors in 185,967 colon cancer patients. Langenbeck's Archives of Surgery 2020, 405, 71 -80.
AMA StyleRosa Schmuck, Michael Gerken, Eva-Maria Teegen, Isabell Krebs, Monika Klinkhammer-Schalke, Felix Aigner, Johann Pratschke, Beate Rau, Stefan Benz. Gender comparison of clinical, histopathological, therapeutic and outcome factors in 185,967 colon cancer patients. Langenbeck's Archives of Surgery. 2020; 405 (1):71-80.
Chicago/Turabian StyleRosa Schmuck; Michael Gerken; Eva-Maria Teegen; Isabell Krebs; Monika Klinkhammer-Schalke; Felix Aigner; Johann Pratschke; Beate Rau; Stefan Benz. 2020. "Gender comparison of clinical, histopathological, therapeutic and outcome factors in 185,967 colon cancer patients." Langenbeck's Archives of Surgery 405, no. 1: 71-80.
Introduction: Gender has been proven to influence the pathophysiology and treatment of numerous diseases, including kidney diseases and hormonal dysfunction like hyperparathyroidism. Thus, higher parathormone levels have been demonstrated in women with end-stage kidney disease, when compared to men. Objectives: We questioned whether female gender is associated with an increased risk for parathyroid nodular hyperplasia and necessary parathyroidectomy in dialysis patients and assessed demographics as well as outcome data for women and men undergoing parathyroidectomy for renal hyperparathyroidism. Patients and Methods: One hundred and thirty patients (men = 75, female = 55) with end-stage renal disease on chronic dialysis and advanced secondary hyperparathyroidism who underwent parathyroidectomy between 2008 and 2014 at our center were analyzed retrospectively. Perioperative characteristics and short-term outcome were evaluated with respect to biological gender. Results: No differences could be demonstrated for patient demography, comorbidities and the perioperative course between males and females. Only preoperative calcium levels were lower in female than in male patients (2.3 ± 0.19 vs. 2.3 ± 0.26, p = 0.04). There were more women, however, with cerebrovascular complications during follow-up (p = 0.04). There was no postoperative mortality, and all complications and comorbidities with exception of cerebrovascular diseases were equally distributed between female and male patients. Conclusion: Overall, we could not demonstrate many significant differences between male and female patients with end-stage renal diseases, chronic dialysis and operated secondary hyperparathyroidism. Only preoperative electrolyte levels were higher in male than in female patients, and cerebrovascular complications developed more often in females than in males during long-term follow-up.
Claudia Bures; Tatjana Skachko; Eva Maria Dobrindt; Johann Pratschke; Deniz Uluk; Martina T. Mogl. Is There a Gender Difference in Clinical Presentation of Renal Hyperparathyroidism and Outcome after Parathyroidectomy? Visceral Medicine 2020, 36, 34 -40.
AMA StyleClaudia Bures, Tatjana Skachko, Eva Maria Dobrindt, Johann Pratschke, Deniz Uluk, Martina T. Mogl. Is There a Gender Difference in Clinical Presentation of Renal Hyperparathyroidism and Outcome after Parathyroidectomy? Visceral Medicine. 2020; 36 (1):34-40.
Chicago/Turabian StyleClaudia Bures; Tatjana Skachko; Eva Maria Dobrindt; Johann Pratschke; Deniz Uluk; Martina T. Mogl. 2020. "Is There a Gender Difference in Clinical Presentation of Renal Hyperparathyroidism and Outcome after Parathyroidectomy?" Visceral Medicine 36, no. 1: 34-40.
Introduction: Gender-specific treatment is gaining growing attention in various fields of medicine. In gastrointestinal cancer, influence of sex on outcome has been discussed, while this has not been the case in neuroendocrine tumors. Overall, the incidence of neuroendocrine neoplasms is rising, especially for appendiceal neuroendocrine neoplasms in women. Also, women seem to have a slight advantage in response to therapy, especially for liver metastases. Objectives: This single-center analysis aimed to investigate gender-specific differences in our cohort related to distribution, therapy, and outcome. Methods: Patients from the NET registry as well as the clinic database were evaluated retrospectively concerning overall survival and response to therapy with respect to gender. A subgroup analysis was carried out for patients with low grading and response to chemotherapy, as well as for patients with good and moderate grading receiving peptide receptor radionuclide therapy and for a group of patients with liver surgery. Results: No specific differences could be detected for overall survival or response to therapy between male and female patients. Mean survival was estimated with 242.2 months (±10.39 SD) altogether and 221.7 months (± 13.02 SD) for male patients and 253.5 months (±15.24 SD) for female patients from the NET registry from initial diagnosis. There was no significant difference between female and male patients (p = 0.136). For patients receiving chemotherapy, overall survival from initial diagnosis was calculated with 26 months (±2.59) and did not show any significant differences between female and male patients 24.8 months (±2.81 SD) vs. 27.8 months (±3.86 SD, p = 0.87). Patients undergoing peptide receptor radionuclide therapy showed a median progression-free survival of 26.9 months (±2.82 SD), with 16.9 (±5.595 SD) and 26.9 months (±3.019 SD) for male and female patients, respectively (p = 0.2). In the group of patients with liver surgery, female patients reached an estimated overall survival of 64.7 months (±4.16 SD), male patients 65.1 months (±2.79 SD, p = 0.562). Conclusion: Our cohort did not reveal significant differences in outcome and response to therapy with regards to gender.
Martina T. Mogl; Eva Maria Dobrindt; Josephine Buschermöhle; Claudia Bures; Johann Pratschke; Holger Amthauer; Christoph Wetz; Henning Jann. Influence of Gender on Therapy and Outcome of Neuroendocrine Tumors of Gastroenteropancreatic Origin: A Single-Center Analysis. Visceral Medicine 2020, 36, 20 -27.
AMA StyleMartina T. Mogl, Eva Maria Dobrindt, Josephine Buschermöhle, Claudia Bures, Johann Pratschke, Holger Amthauer, Christoph Wetz, Henning Jann. Influence of Gender on Therapy and Outcome of Neuroendocrine Tumors of Gastroenteropancreatic Origin: A Single-Center Analysis. Visceral Medicine. 2020; 36 (1):20-27.
Chicago/Turabian StyleMartina T. Mogl; Eva Maria Dobrindt; Josephine Buschermöhle; Claudia Bures; Johann Pratschke; Holger Amthauer; Christoph Wetz; Henning Jann. 2020. "Influence of Gender on Therapy and Outcome of Neuroendocrine Tumors of Gastroenteropancreatic Origin: A Single-Center Analysis." Visceral Medicine 36, no. 1: 20-27.
Background and Aims: There are only few data on the influence of cinacalcet on the outcome of parathyroidectomy in patients with renal hyperparathyroidism. Indication and timing of surgery have changed since its introduction, especially with regard to kidney transplantation. Therefore, we retrospectively analyzed patients undergoing parathyroidectomy for renal hyperparathyroidism in our institution. Material and methods: Between 2008 and 2015, 196 consecutive operations in 191 patients were analyzed. About 80 operations (41%) were performed in patients receiving cinacalcet compared with 116 operations (59%) in patients without cinacalcet. Clinical data, preoperative medication, pre- and postoperative laboratory values, type and details of surgery including complications, as well as cardiovascular complications and kidney transplantation with graft function were recorded. Results: Demographical data were similar in patients with or without cinacalcet treatment. A total of 54% of patients received a kidney graft before or after parathyroidectomy. Pre- and postoperative parathormone levels were similar in both groups (preoperatively 755 vs 742 ng/L, postoperatively 50 vs 46 ng/L, p > 0.10), whereas patients with cinacalcet showed significantly lower calcium levels preoperatively (2.28 vs 2.41 mmol/L, p = 0.0002). There was no difference in recurrence or persistence of hyperparathyroidism, duration of surgery, hospital stay, or complication rate. Creatinine levels in patients with tertiary hyperparathyroidism were similar after 1-year follow-up. Conclusion: Cinacalcet did not influence outcome of patients with parathyroidectomy for renal hyperparathyroidism and can be safely offered to patients not responding to medical treatment.
M. T. Mogl; T. Skachko; Eva Maria Dobrindt; P. Reinke; C. Bures; J. Pratschke; N. Rayes. Surgery for Renal Hyperparathyroidism in the Era of Cinacalcet: A Single-Center Experience. Scandinavian Journal of Surgery 2020, 110, 66 -72.
AMA StyleM. T. Mogl, T. Skachko, Eva Maria Dobrindt, P. Reinke, C. Bures, J. Pratschke, N. Rayes. Surgery for Renal Hyperparathyroidism in the Era of Cinacalcet: A Single-Center Experience. Scandinavian Journal of Surgery. 2020; 110 (1):66-72.
Chicago/Turabian StyleM. T. Mogl; T. Skachko; Eva Maria Dobrindt; P. Reinke; C. Bures; J. Pratschke; N. Rayes. 2020. "Surgery for Renal Hyperparathyroidism in the Era of Cinacalcet: A Single-Center Experience." Scandinavian Journal of Surgery 110, no. 1: 66-72.
Immunosuppression is essential after liver transplantation (LT). It, however, increases the risk for cancer. To evaluate the prevalence and outcome of upper gastrointestinal (GI) tract cancer in LT patients and assess the perioperative risk of surgery for the upper GI malignancies post-LT. 2855 patients underwent LT at our clinic from 1988 to 2018. 20 patients developed upper GI cancer. Data were retrospectively extracted from our database. Analysis included patients' specific data, tumor histopathology and stage, the treatment given and survival. 23 patients developed upper GI malignancies (2 gastric and 18 esophageal cancers; 3 excluded), translating to a incidence of 26.4 per 100,000 population per year. All patients were male. 80% showed alcohol-induced cirrhosis before LT. Most of the tumors were diagnosed at a stage ≥III. 70% underwent surgery and 78.6% developed postoperative complications. One-year-survival was 50%. Total survival rate was 28.6% with a median follow-up of 10 months (range: 0-184). Upper GI malignancies are more common after LT compared to the general population. Men after LT, due to alcohol-induced liver cirrhosis, are at a higher risk. Upper GI surgery after LT can be safe, but the severe risk for complications and a poor survival require strict indications.
E. M. Dobrindt; M. Biebl; S. Rademacher; C. Denecke; A. Andreou; J. Raakow; D. Kröll; R. Öllinger; J. Pratschke; S. S. Chopra. De-novo Upper Gastrointestinal Tract Cancer after Liver Transplantation: A Demographic Report. 2020, 11, 71 -80.
AMA StyleE. M. Dobrindt, M. Biebl, S. Rademacher, C. Denecke, A. Andreou, J. Raakow, D. Kröll, R. Öllinger, J. Pratschke, S. S. Chopra. De-novo Upper Gastrointestinal Tract Cancer after Liver Transplantation: A Demographic Report. . 2020; 11 (2):71-80.
Chicago/Turabian StyleE. M. Dobrindt; M. Biebl; S. Rademacher; C. Denecke; A. Andreou; J. Raakow; D. Kröll; R. Öllinger; J. Pratschke; S. S. Chopra. 2020. "De-novo Upper Gastrointestinal Tract Cancer after Liver Transplantation: A Demographic Report." 11, no. 2: 71-80.
Vascular variations of the extrahepatic artery occur in up to 50% of the population. Exact knowledge of any anomalies is of great significance in hepatobiliary surgery to avoid perioperative complications. In fact, in liver transplant, vascular complications are rare but have a major impact on graft function and survival. This study evaluated variations of the extrahepatic artery in donors and recipients as risk factors for vascular complications after liver transplant. From January 2010 until June 2015, 469 liver transplant procedures were performed at our institution. We included 323 patients in our retrospective analysis after exclusion of retransplants, split-livertransplants, and pediatric patients. We analyzed the impact of anatomic variations of recipients and donors on postoperative vascular complications and organ and patient survival. Of total study recipients, 71.2% had a normal vascular supply according to Michel classification I. However, these patients developed significantly more vascular complications (25.65%) than those with vascular anomalies (15.05%), especially showing higher incidence of arterial stenosis (8.26% vs 2.15%). In contrast, vascular variations in donors and the need for a vascular reconstruction of the graft led to significantly higher mortality (26.76% vs 15.48%). An abnormality of the graft did not influence incidence of postoperative complications or graft survival. Unexpectedly, recipients with variations of the hepatic artery and grafts with an abnormal arterial supply did not show higher rates of com-plications or mortality. Only vascular reconstruction of the graft before transplant raised the mortality of recipients.
Eva M. Teegen; Brigitta Globke; Timm Denecke; Andreas Pascher; Robert Öllinger; Johann Pratschke; Sascha S. Chopra. Vascular Anomalies of the Extrahepatic Artery as a Predictable Risk Factor for Complications After Liver Transplant. Experimental and Clinical Transplantation 2019, 17, 522 -528.
AMA StyleEva M. Teegen, Brigitta Globke, Timm Denecke, Andreas Pascher, Robert Öllinger, Johann Pratschke, Sascha S. Chopra. Vascular Anomalies of the Extrahepatic Artery as a Predictable Risk Factor for Complications After Liver Transplant. Experimental and Clinical Transplantation. 2019; 17 (4):522-528.
Chicago/Turabian StyleEva M. Teegen; Brigitta Globke; Timm Denecke; Andreas Pascher; Robert Öllinger; Johann Pratschke; Sascha S. Chopra. 2019. "Vascular Anomalies of the Extrahepatic Artery as a Predictable Risk Factor for Complications After Liver Transplant." Experimental and Clinical Transplantation 17, no. 4: 522-528.
Gender-Medizin in der Chirurgie bedeutet nicht nur, dass Erkrankungen in Prävalenz, Erkrankungsalter und Schweregrad bei Männern und Frauen variieren, sondern dass die Behandlung durch die unterschiedliche Anatomie und Biologie erschwert werden kann. Hinzu kommen sozioökonomische und gesellschaftliche Aspekte, wie z. B. unterschiedliches Screeningverhalten und der Zugang zu ärztlichen Leistungen, die den Therapiebeginn beeinflussen können. Alle Facetten beeinflussen direkt Outcome, Prognose und Lebensqualität nach viszeralchirurgischen Eingriffen. Dennoch werden heutzutage Frauen und Männer in der Viszeralchirurgie nach denselben Strategien behandelt. Somit besteht die Notwendigkeit, das Bewusstsein und Wissen in Bezug auf geschlechtsspezifische Unterschiede auch in der Chirurgie zu schärfen, um eine patientenindividuellere Medizin anzubieten und beispielsweise Risiken und Benefit noch konkreter einschätzen zu können.
E. M. Teegen; B. Rau; I. Gockel; N. Kreuser. Geschlechtsspezifische Aspekte in der Viszeralchirurgie. Der Gastroenterologe 2019, 14, 85 -90.
AMA StyleE. M. Teegen, B. Rau, I. Gockel, N. Kreuser. Geschlechtsspezifische Aspekte in der Viszeralchirurgie. Der Gastroenterologe. 2019; 14 (2):85-90.
Chicago/Turabian StyleE. M. Teegen; B. Rau; I. Gockel; N. Kreuser. 2019. "Geschlechtsspezifische Aspekte in der Viszeralchirurgie." Der Gastroenterologe 14, no. 2: 85-90.
Background Direct acting antivirals allow efficient and safe treatment of hepatitis C (HCV) before and after liver transplantation. However, the impact of sofosbuvir on the graft, diabetes and on kidney function is not answered yet. Primary endpoint of this analysis was the evaluation of kidney function after AVT. Secondary endpoints were the assessment of extrahepatic manifestation of HCV‐infection by diabetes mellitus and the histopathological changes in terms of inflammation, content of fat and fibrosis stage. Methods From 2014 to 4/2015, 100 patients with HCV‐recurrence after LT were successfully treated with antiviral treatment. 98 received a sofosbuvir‐based regimen. Indication was based on genotype, transplant fibrosis stage and urgency. Biopsies were evaluated before and after treatment. Renal function and diabetes were assessed before, during and after antiviral treatment. Results All patients achieved sustained virological response. A significant improvement of inflammation (p=0.001) and fibrosis stage (p=0.031) were observed. Significantly less insulin was required in 32 patients with diabetes (p<0.001) to keep Hb1Ac unchanged after antiviral treatment. Kidney function was stable during, 12 weeks after and 48 weeks after antiviral therapy. Stages of renal insufficiency were comparable before and after antiviral treatment. Conclusion Successful sofosbuvir‐based AVT leads to a variety of positive development in transplant patients including a significant improvement of inflammation, fat content and fibrosis, a significant decrease of daily insulin dose and no significant impairment of kidney function. This article is protected by copyright. All rights reserved.
Eva M. Teegen; Michael Dürr; Max M. Maurer; Franziska Eurich; Antonia Vollbort; Brigitta Globke; Marcus Bahra; Hendrik Blaeker; Johann Pratschke; Dennis Eurich. Evaluation of histological dynamics, kidney function and diabetes in liver transplant patients after antiviral treatment with direct-acting antivirals: Therapy of HCV-recurrence. Transplant Infectious Disease 2018, 21, e13020 .
AMA StyleEva M. Teegen, Michael Dürr, Max M. Maurer, Franziska Eurich, Antonia Vollbort, Brigitta Globke, Marcus Bahra, Hendrik Blaeker, Johann Pratschke, Dennis Eurich. Evaluation of histological dynamics, kidney function and diabetes in liver transplant patients after antiviral treatment with direct-acting antivirals: Therapy of HCV-recurrence. Transplant Infectious Disease. 2018; 21 (1):e13020.
Chicago/Turabian StyleEva M. Teegen; Michael Dürr; Max M. Maurer; Franziska Eurich; Antonia Vollbort; Brigitta Globke; Marcus Bahra; Hendrik Blaeker; Johann Pratschke; Dennis Eurich. 2018. "Evaluation of histological dynamics, kidney function and diabetes in liver transplant patients after antiviral treatment with direct-acting antivirals: Therapy of HCV-recurrence." Transplant Infectious Disease 21, no. 1: e13020.
Background Hepatitis B (HBV)‐associated end‐stage liver disease used to be a relevant indication for liver transplantation (LT). After transplantation, HBV‐reinfection remains a serious issue. Different strategies to prevent HBV‐reinfection range from the single application of immunoglobulins (HBIG), to the use of modern nucleoside/nucleotide analogues (NUC) in combination with HBIG, followed by HBIG‐discontinuation. The aim of this analysis was to compare different strategies and to sum up the results of 30 years at a high‐volume transplant center and deliver additional information on the histopathological level. Methods Data of 372 liver transplantations performed for the HBV‐induced liver disease in 352 patients were extracted from a prospectively organized database. HBV‐reinfection was determined in the entire cohort, according to the mode of HBV‐prophylaxis. Differences in survival rates were analyzed in patients with successful prophylaxis, untreated and controlled HBV‐reinfection. Histopathological results were obtained from protocol biopsies in 151 patients. Results HBV‐reinfection was significantly associated with the type of prophylaxis, presence of HBs‐Antigen at the moment of LT, transplant year and influencing the overall survival before 2005. After the introduction of modern NUCs, HBV‐reinfection stopped to impact HBV‐associated transplant loss and survival. Controlled HBV‐infection prevents from HBV‐associated transplant hepatitis and fibrosis development. The role of HBIG declines in favor of NUCs. Conclusions Uncontrolled HBV‐reinfection does not occur any more. Even in the presence of Hbs‐antigen, transplant fibrosis does not develop. The most reliable mode to prevent HBV‐recurrence remains the combination of NUCs with a high genetic barrier and HBIG. However, HBIG can safely be discontinued after LT. This article is protected by copyright. All rights reserved.
Eva Maria Teegen; Max Magnus Maurer; Brigitta Globke; Johann Pratschke; Dennis Eurich. Liver transplantation for Hepatitis-B-associated liver disease - Three decades of experience. Transplant Infectious Disease 2018, 21, e12997 .
AMA StyleEva Maria Teegen, Max Magnus Maurer, Brigitta Globke, Johann Pratschke, Dennis Eurich. Liver transplantation for Hepatitis-B-associated liver disease - Three decades of experience. Transplant Infectious Disease. 2018; 21 (1):e12997.
Chicago/Turabian StyleEva Maria Teegen; Max Magnus Maurer; Brigitta Globke; Johann Pratschke; Dennis Eurich. 2018. "Liver transplantation for Hepatitis-B-associated liver disease - Three decades of experience." Transplant Infectious Disease 21, no. 1: e12997.
Introduction. Adrenal metastasis of hepatocellular carcinoma (HCC) is a rare entity and can be treated by resection, local ablative therapy, or systemic therapy. Unfortunately, data about treatment outcome, especially in liver transplant recipients, are rare. Patients and Methods. From 2005 to 2015, 990 liver resections and 303 liver transplantations because of HCC were performed at our clinic. We retrospectively analyzed treatment outcome of the patients with metachronous adrenal metastasis of HCC, who received either resection, local ablation, or surveillance only. Results. 10 patients were identified (0.8%). 7 patients received liver transplantation for primary HCC therapy, 3 liver resection, and 1 a local ablative therapy. 8 patients underwent adrenalectomy (one via retroperitoneoscopy), one was treated with local ablation, and one had surveillance only. Seven out of eight patients had no surgical complications and one experienced a pancreatic fistula, treated conservatively. 37.5% of the resected patients had recurrence 1 year after adrenalectomy and 75% after 2 years. The mean survival time after primary diagnosis of HCC was 96.6±22.4 months. After adrenalectomy, the mean survival time was 112.4±25.2 months. The mean time until tumor recurrence was 13.2±3.8 in the total cohort and 15.8±3.8 months in patients after adrenalectomy. The estimated overall survival after adrenalectomy was 77.2±17.4 months. Conclusion. Metachronous adrenal metastasis occured in less than 1% of HCC patients. Adrenalectomy is a safe procedure and leads to acceptable survival rates even after liver transplantion. Therefore, it should be performed whenever the primary tumor is well controlled and the patient is in adequate physical condition.
Eva M. Teegen; Martina T. Mogl; Johann Pratschke; Nada Rayes. Adrenal Metastasis of Hepatocellular Carcinoma in Patients following Liver Resection or Liver Transplantation: Experience from a Tertiary Referral Center. International Journal of Surgical Oncology 2018, 2018, 1 -6.
AMA StyleEva M. Teegen, Martina T. Mogl, Johann Pratschke, Nada Rayes. Adrenal Metastasis of Hepatocellular Carcinoma in Patients following Liver Resection or Liver Transplantation: Experience from a Tertiary Referral Center. International Journal of Surgical Oncology. 2018; 2018 ():1-6.
Chicago/Turabian StyleEva M. Teegen; Martina T. Mogl; Johann Pratschke; Nada Rayes. 2018. "Adrenal Metastasis of Hepatocellular Carcinoma in Patients following Liver Resection or Liver Transplantation: Experience from a Tertiary Referral Center." International Journal of Surgical Oncology 2018, no. : 1-6.