In 1991, Pereira et al.¹ x 1 Pereira, B.J., Milford, E.L., Kirkman, R.L., and Levey, A.S. Transmission of hepatitis C virus by organ transplantation. N Engl J Med. 1991; 325: 454–460 Crossref | PubMed | Scopus (291) | Google Scholar See all References demonstrated that hepatitis C virus (HCV) can be transmitted by organ transplantation. The number of organ donors showing antibodies against HCV (HCV-AB) is estimated to be approximately 5% of all potential cadaveric organ donors in Europe and the USA.² x 2 Pereira, B.J. and Levey, A.S. Hepatitis C virus infection in dialysis and renal transplantation. Kidney Int. 1997; 51: 981–999 Abstract | Full Text PDF | PubMed | Scopus (335) | Google Scholar See all References ^{, 3} x 3 Candinas, D., Joller-Jemelka, H.I., Schlumpf, R. et al. Hepatitis C RNA prevalence in a Western European organ donor pool and virus transmission by organ transplantation. J Med Microbiol. 1994; 41: 220–223 Crossref | PubMed | Scopus (13) | Google Scholar See all References ^{, 4} x 4 Natov, S.N. and Pereira, B.J. Transmission of viral hepatitis by kidney transplantation: donor evaluation and transplant policies (part 1: hepatitis B virus). Transpl Infect Dis. 2002; 4: 117–123 Crossref | PubMed | Scopus (42) | Google Scholar See all References In contrast, the prevalence of HCV is estimated be around 0.5% to 0.7% in the German adult general population (HCV-AB positive).⁵ x 5 Palitzsch, K.D., Hottentrager, B., Schlottmann, K. et al. Prevalence of antibodies against hepatitis C virus in the adult German population. Eur J Gastroenterol Hepatol. 1999; 11: 1215–1220 Crossref | PubMed | Scopus (60) | Google Scholar See all References ^{, 6} x 6 Schreier, C., Radun, D., Neuhauser, H. et al. Hepatitis C. Robert Koch Institut, Berlin; 2003 Google Scholar See all References ^{, 7} x 7 Thierfelder, W., Meisel, H., Schreier, E. et al. Prevalence of antibodies against hepatitis A, hepatitis B and hepatitis C virus in the german population. Gesundheitswesen. 1991; 61: 110–114 Google Scholar See all References For other countries in Western Europe, the number varies and ranges from 0.5% to 2.0%.⁸ x 8 Trepo, C. and Pradat, P. Hepatitis C virus infection in Western Europe. J Hepatol. 1999; 31: 80–83 Abstract | Full Text PDF | PubMed | Google Scholar See all References Taking into account the shortage of organs, loss of organ donors due to false-positive HCV-AB is a relevant problem in transplantation.

Infections after liver transplantation are the main cause of death in the first year. Recent reports indicate that NOD2 gene mutations increase the risk for inflammatory bowl disease and the severity of graft-versus-host disease in bone marrow transplant patients. Data on polymorphisms in liver transplant patients are sparse. We analyzed 13 single-nucleotide polymorphisms (SNPs) of 13 different gene variants including the SNPs of NOD2 genes from liver recipients. The aim of the study was to evaluate the impact of the SNPs on dialysis-dependent kidney failure, the incidence of infections and patient survival.

Perioperative care of patients undergoing liver transplantation (LT) is very complex. Metabolic derangements, hypothermia, coagulopathy and thromboses, severe infections, and graft dysfunction can affect outcomes. In this manuscript, we discuss several perioperative problems that can be encountered in LT recipients. The authors present the most up-to-date information regarding predicting and treating hemodynamic instability, coagulation monitoring and management, postoperative ventilation strategies and early extubation, management of infections, and ESLD-related pulmonary complications. In addition, early post-transplant allograft dysfunction will be discussed.

Acquired hemophilia A (AHA) is a rare disease with a prevalence in Europe of 1.5 per million. This diagnosis is significantly delayed in about one-third of all cases, leading to deferred treatment. The main signs of AHA are spontaneous bleeding seen in about two-thirds of all patients. AHA can be lethal in 20% of all symptomatic cases. This patient population’s main standard laboratory finding is a prolonged aPTT (activated prothrombin Time) with otherwise normal coagulation results. In addition, antibodies against FVIII (in Bethesda Units) and a quantitative reduction of FVIII activity are necessary to confirm AHA. The therapy of acute bleeding related to AHA is based on the following main principles: Pharmacologic control of the bleeding is of absolute importance. It can be achieved by administering either recombinant activated FVIIa “bypass therapy”; activated prothrombin complex; or Emicizumab, a bispecific monoclonal antibody. Eradication of the FVIII antibodies should be initiated simultaneously. The combination of steroids with cyclophosphamide leads to the highest eradication rates. Causes of AHA may be related to neoplasms, autoimmune diseases, and pregnancy. We report on a patient who underwent four surgical procedures before the diagnosis of AHA was established.

Background: Switching stable liver transplant (LT) recipients from twice-daily immediate-release tacrolimus (IR-Tac) to once-daily MeltDose^® extended-release tacrolimus (LCPT) has been proven safe and well tolerated. Moreover, the switch has been associated with enhanced treatment adherence, improvement of tremors, and preserved renal function. Here, we hypothesized that switching to LCPT early after LT may enhance long-term patient outcomes significantly. Methods: This single-center, observational study investigated the long-term safety of LCPT in a large cohort of LT recipients (n = 100). Allograft function, emerging adverse events, the incidence of rejection reactions, renal function, lipid and glucose metabolism, and treatment adherence were assessed over 24 months. Results: In 56% of patients, the switch was conducted within 4 weeks post-transplantation. Adverse events occurred in 90% of patients during the 24-month follow-up, including gastrointestinal complications (28%), neurological symptoms (28%), skin disorders (26%), metabolic disorders (22%), and fatigue (18%). Seven patients (7%) developed renal insufficiency, and five patients (5%) developed renal failure. Three episodes of chronic graft rejection reactions (3%) and a single transplant failure (1%) were observed over 24 months. LCPT was discontinued in 10 patients. Liver and renal function markers, blood lipids (cholesterol and triglycerides), and glucose levels remained stable over the 24-month follow-up. However, 58% of LT recipients had one of their liver function markers elevated at baseline (i.e., before the switch), 28% had low glomerular filtration rate (GFR < 60 mL/min/1.73 m²), and 18% had high serum creatinine (>1.3 mg/dL). In these subgroups, the early switch to LCPT was associated with a significant decrease in liver enzymes (p < 0.001 for alanine transaminase; p = 0.032 for gamma-glutamyl transferase; and p < 0.001 for total bilirubin) and a significant decrease in serum creatinine levels (p < 0.001). Self-reported treatment adherence was good and consistent throughout the study. Conclusions: The early switch from IR-Tac to LCPT was safe and effective in our cohort and may be particularly beneficial for patients with suboptimal liver and renal function following LT.