No abstract

rum HCV-RNA levels in recipients before, during, and after The pathogenesis of hepatitis C virus (HCV) infectionOLT to obtain kinetic information on the dynamics of HCV is likely to be associated with viral replication in vivo, replication and clearance in vivo. Liver transplantation recipbut little is known concerning the dynamics of HCV ients are ideally suited to provide insights into the mechaturnover. We performed serial measurements of serum nisms of HCV pathogenesis, because hepatic HCV replication HCV-RNA levels following orthotopic liver transplantais terminated at the time of removal of the infected liver, and tion (OLT) in nine patients with HCV-positive cirrhosis.the clinical setting following reperfusion of the engrafted liver Serum HCV-RNA levels were determined by quantitaprovides a model for monitoring dynamic processes of graft tive polymerase chain reaction before, immediately reinfection. after, and for up to 1 month after OLT. There was a rapid decline in HCV-RNA levels from 3.1 { 1.3 1 10 5 copies/ PATIENTS AND METHODS mL (mean { SEM) preoperatively to 0.15 { 0.6 1 10 5 copies/mL on the first and 0.16 { 0.6 1 10 5 copies/mL on the therapy including steroid bolus administration. In mostAll patients received a quadruple immunosuppressive regimen for patients, serum virions continued to increase averaging the first week after OLT consisting of prednisolone, azathioprine, 11.6 { 2.8 1 10 5 copies/mL on the 30th postoperative day. antithymocyte globulin, and cyclosporin A or tacrolimus. Murine These findings indicate that the half-life of HCV is quite monoclonal antibody (OKT-3) was not used in any of the patients. short, and that extrahepatic viral replication contrib-Subsequently, patients underwent a triple immunosuppressive regiutes little to the total virus pool in serum. Furthermore, men for 3 weeks (prednisolone, azathioprine, and cyclosporin A or tacrolimus). Six of the nine patients developed histologically conthe marked HCV replication beginning as early as the firmed acute rejection and in five, steroid bolus injection was initithird postoperative day strongly suggests that the liver ated 8 or 9 days after OLT. Liver biopsy was performed in all patients graft is rapidly reinfected by HCV after OLT. (HEPATOLbetween 7 to 10 days after OLT. Serum samples were collected at 1 day before OLT and daily after OLT for a period of up to 30 days and stored at 080ЊC. In addition, for six of the nine patients, serum samples were also collected during Hepatitis C virus (HCV) reinfection after orthotopic liver the transplantation procedure, i.e., before starting the operation, transplantation (OLT) occurs in almost all patients with preduring the anhepatic phase, during reperfusion of the graft, and at transplantation viremia, and 50% to 70% of these patients regular intervals for the first day after reperfusion. develop graft hepatitis which is mild in most cases.1-6 How-The presence of antibody to HCV (anti-HCV) was tested for by ever, in some patients, graft hepatitis can be severe, with a secon...

No abstract

This prospective multicenter study investigated the effect of hospital caseload on early postoperative outcome of surgery for carcinoma of the colon in 75 German hospitals and included 2293 patients. The hospitals were divided into those with a caseload of 1-30 (group A), 31-60 (group B), and more than 60 (group C) operations. Increasing caseload was associated only with fewer general postoperative complications. It was also associated with significantly greater use of antibiotic prophylaxis. No significant differences between the groups were found in resection rates, intraoperative complications, specific postoperative complications, overall postoperative morbidity, hospital mortality, or 30-day mortality. The significance of hospital caseload for the short-term postoperative outcome following surgery on the colon should not be overestimated. Basing conclusions about the results to be expected simply on the case volume is impermissible. On the basis of the available data it is not possible to establish a threshold value, that is, a minimum number of required operations.

Hereditary hemorrhagic teleangiectasia, or M. Osler (Osler-Weber-Rendu disease), is an autosomal dominant, systemic fibrovascular dysplasia. This may lead to increased liver blood flow from arteriovenous fistulas. A 45-year-old woman with a known M. Osler was admitted for liver transplantation. On admission, exertional dyspnea was the predominant symptom. Radiological investigations revealed multiple intrahepatic arteriovenous fistulas and consecutive high-output heart failure. Laboratory findings revealed remarkably elevated bilirubin and alkaline phosphatase. To alleviate the high-output cardiac failure, the hepatic artery was ligated. Fourteen months later, the patient presented again with increased levels of bilirubin and recurrent bleeding episodes from esophageal varices grade IV. The patient underwent liver transplantation and post-transplant recovery was excellent. A hyperdynamic circulatory state due to a hepatic M. Osler has been treated in several cases by ligation or embolization of the hepatic artery. This procedure, however, is recommended only for patients with normal liver function and carries a considerably risk of bile duct necrosis.

No abstract

Our results indicate that treatment with anti-interleukin-2 receptor antibody as part of quadruple induction therapy after orthotopic liver transplantation is safe and effective and shows fewer steroid-sensitive rejection episodes as well as fewer side effects when compared with quadruple induction therapy including ATG.

Within a 17-month period, 130 orthotopic liver transplantations were performed in our hospital. Nine of these were retransplantations and were not included in our analysis. In the remaining 121 patients, splenectomy was performed in 34 patients, either synchronously with the transplant procedure (27 patients) or in the postoperative period (7 patients). Indications for splenectomy were lienalis-steal syndrome in 15 patients and hypersplenism in 15 cases. The number of rejection episodes was fairly equal in both groups (splenectomized vs. non-splenectomized, 61.7% vs. 63.9%, respectively). There was a marked difference in the frequency of infectious episodes (61.7% vs. 25.3%) that resulted in a decreased survival rate (77.5% vs. 95.4%) for splenectomized patients. Therefore, we recommend splenectomy only for very selected patients and investigate the banding of the splenic artery as an alternative.