Latest documents http://publikationen.ub.uni-frankfurt.de/index/index/ Mon, 10 Dec 2012 08:20:13 +0200 Mon, 10 Dec 2012 08:20:13 +0200 http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/26769 Objectives. This summary evaluates the outcomes of orthotopic liver transplantation (OLT) of HIV-positive patients in Germany. Methods. Retrospective chart analysis of HIV-positive patients, who had been liver-transplanted in Germany between July 1997 and July 2011. Results. 38 transplantations were performed in 32 patients at 9 German transplant centres. The reasons for OLT were end-stage liver disease (ESLD) and/or liver failure due to hepatitis C (HCV) (n = 19), hepatitis B (HBV) (n = 10), multiple viral infections of the liver (n = 2) and Budd-Chiari-Syndrome. In July 2011 19/32 (60%) of the transplanted patients were still alive with a median survival of 61 months (IQR (interquartile range): 41-86 months). 6 patients had died in the early post-transplantation period from septicaemia (n = 4), primary graft dysfunction (n = 1), and intrathoracal hemorrhage (n = 1). Later on 7 patients had died from septicaemia (n = 2), delayed graft failure (n = 2), recurrent HCC (n = 2), and renal failure (n = 1). Recurrent HBV infection was efficiently prevented in 11/12 patients; HCV reinfection occurred in all patients and contributed considerably to the overall mortality. Conclusions. Overall OLT is a feasible approach in HIV-infected patients with acceptable survival rates in Germany. Reinfection with HCV still remains a major clinical challenge in HIV/HCV coinfection after OLT. Evrim Anadol; Susanne Beckebaum; Klaus Radecke; Andreas Paul; Alexander Zoufaly; Markus Bickel; Florian Hitzenbichler; Tom M. Ganten; Jens Martin Kittner; Matthias Stoll; C. Berg; Steffen Manekeller; Jörg C. Kalff; Tilman Sauerbruch; Jürgen Rockstroh; Ulrich Spengler article http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/26769 Fri, 12 Oct 2012 08:20:13 +0200 http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/7871 Background: The potential anti-cancer effects of mammalian target of rapamycin (mTOR) inhibitors are being intensively studied. To date, however, few randomised clinical trials (RCT) have been performed to demonstrate anti-neoplastic effects in the pure oncology setting, and at present, no oncology endpoint-directed RCT has been reported in the high-malignancy risk population of immunosuppressed transplant recipients. Interestingly, since mTOR inhibitors have both immunosuppressive and anti-cancer effects, they have the potential to simultaneously protect against immunologic graft loss and tumour development. Therefore, we designed a prospective RCT to determine if the mTOR inhibitor sirolimus can improve hepatocellular carcinoma (HCC)-free patient survival in liver transplant (LT) recipients with a pre-transplant diagnosis of HCC. Methods: The study is an open-labelled, randomised, RCT comparing sirolimus-containing versus mTOR-inhibitor-free immunosuppression in patients undergoing LT for HCC. Patients with a histologically confirmed HCC diagnosis are randomised into 2 groups within 4-6 weeks after LT; one arm is maintained on a centre-specific mTOR-inhibitor-free immunosuppressive protocol and the second arm is maintained on a centre-specific mTOR-inhibitor-free immunosuppressive protocol for the first 4-6 weeks, at which time sirolimus is initiated. A 3-year recruitment phase is planned with a 5-year follow-up, testing HCC-free survival as the primary endpoint. Our hypothesis is that sirolimus use in the second arm of the study will improve HCC-free survival. The study is a non-commercial investigator-initiated trial (IIT) sponsored by the University Hospital Regensburg and is endorsed by the European Liver and Intestine Transplant Association; 13 countries within Europe, Canada and Australia are participating. Discussion: If our hypothesis is correct that mTOR inhibition can reduce HCC tumour growth while simultaneously providing immunosuppression to protect the liver allograft from rejection, patients should experience less post-transplant problems with HCC recurrence, and therefore could expect a longer and better quality of life. A positive outcome will likely change the standard of posttransplant immunosuppressive care for LT patients with HCC. (trial registered at www.clinicaltrials.gov: NCT00355862) (EudraCT Number: 2005-005362-36) Andreas A. Schnitzbauer; Carl Zuelke; Christian Graeb; Justine Rochon; Itxarone Bilbao; Patrizia Burra; Koert P. de Jong; Christophe Duvoux; Norman M. Kneteman; Rene Adam; Wolf Otto Bechstein; Thomas Becker; Susanne Beckebaum; Olivier Chazouilleres; Umberto Cillo; Michele Colledan; Fred Fandrich; Jean Gugenheim; Johann P. Hauss; Michael Heise; Ernest Hidalgo; Neville Jamieson; Alfred Konigsrainer; Philipp E. Lamby; Jan P. Lerut; Heikki Makisalo; Raimund Margreiter; Vincenzo Mazzaferro; Ingrid Mutzbauer; Gerd Otto; Georges-Philippe Pageaux; Antonio D. Pinna; Jacques Pirenne; Magnus Rizell; Giorgio Rossi; Lionel Rostaing; Andre Roy; Victor Sanchez Turrion; Jan Schmidt; Roberto I. Troisi; Bart van Hoek; Umberto Valente; Philippe Wolf; Heiner Wolters; Darius F. Mirza; Tim Scholz; Rudolf Steininger; Gunnar Soderdahl; Simone I. Strasser; Karl-Walter Jauch; Peter Neuhaus; Hans J. Schlitt; Edward K. Geissler article http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/7871 Tue, 10 Aug 2010 14:49:50 +0200