14 results on '"Steinmüller, T"'
Search Results
2. THE ADIPONECTIN AND PROINSULIN METABOLISM AFTER LIVING DONOR LIVER TRANSPLANTATION.
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Malinowski, M., Konrad, T., Nolting, S., Hünerbein, D., Dobling, H., Steinmüller, T., Pfützner, A., Lock, J. F., Neuhaus, P., and Stockmann, M.
- Published
- 2010
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3. ALLOTRANSPLANTATION OF ENCAPSULATED HUMAN PARATHYROID TISSUE IN PATIENTS WITH PERMANENT HYPOPARATHYROIDISM.
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Ulrich, F, Klupp, J, Thürmer, F, Rayes, N, Seehofer, D, Tullius, S G., Geigle, P, Steinmüller, T, and Neuhaus, P
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- 2004
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4. Clinical Presentation, Treatment, and Outcome of Parathyroid Carcinoma: Results of the NEKAR Retrospective International Multicenter Study.
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Lenschow C, Schrägle S, Kircher S, Lorenz K, Machens A, Dralle H, Riss P, Scheuba C, Pfestroff A, Spitzweg C, Zielke A, Nießen A, Dotzenrath C, Riemann B, Quinkler M, Vorländer C, Zahn A, Raue F, Chiapponi C, Iwen KA, Steinmüller T, Kroiss M, and Schlegel N
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- Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Internationality, Male, Middle Aged, Parathyroid Neoplasms mortality, Prognosis, Retrospective Studies, Survival Rate, Treatment Outcome, Young Adult, Parathyroid Neoplasms diagnosis, Parathyroid Neoplasms therapy
- Abstract
Objective: In this retrospective cohort study, we describe the clinical presentation and workup of parathyroid carcinoma (PC) and determine its clinical prognostic parameters. Primary outcome was recurrence free survival., Summary Background Data: PC is an orphan malignancy for which diagnostic workup and treatment is not established., Methods: Eighty-three patients were diagnosed with PC between 1986 and 2018. Disease-specific and recurrence-free survivals were estimated with the Kaplan-Meier method. Risk factors for recurrence were identified by binary logistic regression with adjustment for age and sex. Thirty-nine tumors underwent central histopathological review., Results: Renal (39.8%), gastrointestinal (24.1%), bone (22.9%), and psychiatric (19.3%) symptoms were the most common symptoms. Surgical treatment was heterogeneous [parathyroidectomy [PTx)] alone: 22.9%; PTx and hemithyroidectomy: 24.1%; en bloc resection 15.7%; others 37.3%] and complications of surgery were frequent (recurrent laryngeal nerve palsy 25.3%; hypoparathyroidism 6%). Recurrence of PC was observed in 32 of 83 cases. In univariate analysis, rate of recurrence was reduced when extended initial surgery had been performed (P = 0.04). In multivariate analysis low T status [odds ratio (OR) = 2.65, 95% confidence interval (CI) 1.02-6.88, P = 0.045], N0 stage at initial diagnosis (OR = 6.32, 95% CI 1.33-30.01, P = 0.02), Ki-67 <10% (OR = 14.07, 95% CI 2.09-94.9, P = 0.007), and postoperative biochemical remission (OR = 0.023, 95% CI 0.001-0.52, P = 0.018) were beneficial prognostic parameters for recurrence-free survival., Conclusion: Despite a favorable overall prognosis, PC shows high rates of recurrence leading to repeated surgery and postoperative recurrent laryngeal nerve palsy and hypoparathyroidism. In view of the reduced recurrence rate in cases of extended surgery, ipsilateral completion surgery may be considered when PC is confirmed., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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5. Total Versus Near-total Thyroidectomy in Graves Disease: Results of the Randomized Controlled Multicenter TONIG-trial.
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Maurer E, Maschuw K, Reuss A, Zieren HU, Zielke A, Goretzki P, Simon D, Dotzenrath C, Steinmüller T, Jähne J, Kemen M, Coerper S, Leister I, Nies C, Hartel M, Türler A, Holzer K, Agha A, Knoop M, Musholt T, Aminossadati B, and Bartsch DK
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- Adult, Female, Follow-Up Studies, Humans, Hypoparathyroidism etiology, Male, Middle Aged, Postoperative Complications diagnosis, Postoperative Complications surgery, Prospective Studies, Risk Assessment, Severity of Illness Index, Thyroidectomy adverse effects, Time Factors, Transplantation, Autologous methods, Treatment Outcome, Young Adult, Graves Disease diagnosis, Graves Disease surgery, Hypoparathyroidism surgery, Parathyroid Glands transplantation, Thyroidectomy methods
- Abstract
Background: Previous data suggest that the incidence of hypoparathyroidism after surgery for Graves disease (GD) is lower after subtotal thyroidectomy compared to total thyroidectomy (TT). The present study evaluated the incidence of postoperative hypoparathyroidism after near-total (NTT) versus TT in GD., Methods/design: In a multicenter prospective randomized controlled clinical trial, patients with GD were randomized intraoperatively to NTT or TT. Primary endpoint was the incidence of transient postoperative hypoparathyroidism. Secondary endpoints were permanent hypoparathyroidism, transient recurrent laryngeal nerve palsy (RLNP), reoperations for bleeding, inadvertently removed parathyroid glands, and recurrent hyperthyroidism after 12 months., Results: Eighteen centers randomized 205 patients to either TT (n = 102) or NTT (n = 103) within 16 months. According to intention-to-treat postoperative transient hypoparathyroidism occurred in 19% (20/103) patients after NTT and in 21% (21 of 102) patients after TT (P = 0.84), which persisted >6 months in 2% and 5% of the NTT and TT groups (P = 0.34). The rates of parathyroid autotransplantation (NTT 24% vs TT 28%, P = 0.50) and transient RLNP (NTT 3% vs TT 4%, P = 0.35) was similar in both groups. The rate of reoperations for bleeding tended to be higher in the NTT group (3% vs 0%, P = 0.07) and the rate of inadvertently removed parathyroid glands was significantly higher after NTT (13% vs 3%, P = 0.01). An existing endocrine orbitopathy improved in 35% and 24% after NTT and TT (P = 0.61). Recurrent disease occurred in only 1 patient after TT (P = 0.34)., Conclusion: NTT for GD is not superior to TT regarding transient postoperative hypoparathyroidism.
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- 2019
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6. Mycophenolatemofetil for immunosuppression after liver transplantation: a follow-up study of 191 patients.
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Pfitzmann R, Klupp J, Langrehr JM, Uhl M, Neuhaus R, Settmacher U, Steinmüller T, and Neuhaus P
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- Adult, Cyclosporine therapeutic use, Drug Administration Schedule, Drug Therapy, Combination, Follow-Up Studies, Humans, Immunosuppressive Agents therapeutic use, Liver Function Tests, Liver Transplantation methods, Liver Transplantation mortality, Middle Aged, Mycophenolic Acid analogs & derivatives, Retrospective Studies, Survival Rate, Tacrolimus therapeutic use, Time Factors, Liver Transplantation immunology, Mycophenolic Acid therapeutic use
- Abstract
Background: Mycophenolatemofetil (MMF) combined with calcineurin inhibitors (CNIs) as immunosuppression after orthotopic liver transplantation (OLT) is still under discussion. We retrospectively investigated the immunosuppressive potency of MMF for treatment of steroid-resistant acute rejection (AR) or chronic rejection (CR), chronic graft dysfunction, and CNI-induced toxicity in patients after OLT., Methods: Between 1988 and 2001 we performed 1386 OLTs in 1258 patients. Since 1995, 191 patients have received MMF after OLT for steroid-resistant AR or CR, chronic graft dysfunction (115 patients), and CNI-induced toxicity (76 patients). The mean follow-up time was 56 months., Results: Of 47 patients with steroid-resistant AR, 12 had been treated with OKT3, without resolving the rejection. Overall, bilirubin and transaminases decreased significantly within 2 weeks after the addition of MMF, and liver function normalized in 38 patients. Five of eight patients with CR demonstrated stable liver function after a follow-up of 55+/-8 months; 52 of 60 patients with chronic graft dysfunction improved within 3 months; and 46 of 59 patients with CNI-induced nephrotoxicity improved after MMF treatment and a reduction of CNIs (with a significant decrease in serum creatinine within 2 weeks and an increase of creatinine clearance within 3 months). Clinical symptoms improved in 10 of 12 patients with neurotoxicity and four of five patients with hepatotoxicity. Side effects of MMF, such as gastrointestinal disorders or bone marrow toxicity, occurred in 60 patients (31.4%). The incidence of infections did not increase. Patient survival was 93%, and graft survival was 88.2%., Conclusions: MMF is a potent and safe immunosuppressive agent in OLT recipients for rescue therapy in AR, CR, or chronic graft dysfunction and helps to reduce the serious toxic side effects of CNIs.
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- 2003
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7. Preoperative antiviral treatment and postoperative prophylaxis in HBV-DNA positive patients undergoing liver transplantation.
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Seehofer D, Rayes N, Naumann U, Neuhaus R, Müller AR, Tullius SG, Berg T, Steinmüller T, Bechstein WO, and Neuhaus P
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- 2-Aminopurine therapeutic use, Adult, Famciclovir, Female, Hepatitis B prevention & control, Humans, Immunoglobulins immunology, Lamivudine therapeutic use, Male, Middle Aged, Recurrence, Retrospective Studies, 2-Aminopurine analogs & derivatives, Antiviral Agents therapeutic use, DNA, Viral analysis, Hepatitis B drug therapy, Liver Transplantation
- Abstract
Background: Despite passive immunoprophylaxis a significant number of patients, especially if hepatitis B virus (HBV) DNA is positive prior to transplantation, develop HBV recurrence. This number might be reduced by lowering viral replication pretransplant with antiviral agents and by postoperative combination of antiviral agents and passive immunoprophylaxis., Patients and Methods: A total of 74 HBV-DNA positive patients who underwent liver transplantation between 9/88 and 4/00 were analyzed retrospectively. Before lamivudine or famciclovir were available, in total 40 patients did not receive any preoperative antiviral therapy. Since 11/93, 17 patients were treated with famciclovir 1500 mg daily, after 4/96 17 patients with lamivudine 150 mg daily prior liver transplantation. Posttransplant all patients received passive immunoprophylaxis aiming at a titer of more than 100 U/liter. In the 34 patients with preoperative antiviral therapy an additional prophylaxis with the respective antiviral agent was applied., Results: Under preoperative famciclovir and lamivudine 30 and 71% of patients became HBV-DNA negative, respectively. Actuarial reinfection rate 2 years after liver transplantation was 48% without antiviral prophylaxis, which was not statistically different from 55% under perioperative famciclovir therapy. In contrast only 18% developed HBV recurrence under perioperative lamivudine treatment. During both antiviral regimens neither pre nor posttransplant severe side effects were observed., Conclusion: Perioperative application of famciclovir is not recommendable, whereas lamivudine seems to lower recurrence rates significantly. Whether the observed effect is due to pre- or postoperative application remains to be addressed in further studies. In addition the long-term course has to be awaited.
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- 2001
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8. Prospective randomized trial to assess the value of preemptive oral therapy for CMV infection following liver transplantation.
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Rayes N, Seehofer D, Schmidt CA, Oettle H, Müller AR, Steinmüller T, Settmacher U, Bechstein WO, and Neuhaus P
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- Administration, Oral, Antiviral Agents adverse effects, Cytomegalovirus Infections etiology, Cytomegalovirus Infections mortality, Female, Ganciclovir adverse effects, Humans, Injections, Intravenous, Male, Middle Aged, Phosphoproteins blood, Prospective Studies, Recurrence, Reoperation, Survival Rate, Viral Matrix Proteins blood, Viremia drug therapy, Viremia etiology, Antiviral Agents administration & dosage, Cytomegalovirus Infections drug therapy, Ganciclovir administration & dosage, Liver Transplantation adverse effects
- Abstract
Background: With the development of sensitive tests to detect cytomegalovirus (CMV) viremia, preemptive approaches become a reasonable alternative to general CMV prophylaxis. We performed a randomized trial comparing pp65-antigenemia guided preemptive therapy using oral ganciclovir with symptom-triggered intravenous ganciclovir treatment., Methods: Eighty-eight of 372 liver transplant recipients developed antigenemia early after orthotopic liver transplantation. Twenty-eight symptomatic patients with antigenemia were excluded from randomization and treated with intravenous ganciclovir. Sixty pp65-antigen-positive asymptomatic patients were randomized to receive either oral ganciclovir 3x1 g/day for 14 days (group 1) or no preemptive treatment (group 2). Patients that developed CMV disease were treated with intravenous ganciclovir 2x5 mg/kg body weight for 14 days. The high-risk (Donor+/Recipient-) patients were equally distributed in the two study groups., Results: Three of 30 (10%) patients on oral ganciclovir developed mild to moderate CMV disease compared with 6/30 (20%) patients in the control group. In the Donor+/Recipient- patients, the incidence of CMV disease was 1/6 and 3/7. All disease episodes resolved after intravenous treatment. The 1- and 3-year patient and organ survival was the same in the study groups and in the patients with or without CMV infection. No deaths related to CMV occurred., Conclusions: The positive predictive value of pp65-antigenemia for the development of CMV disease was very low, and, in 28/88 patients (32%), antigenemia did not precede symptoms. Therefore, pp65-antigenemia is of limited value in deciding on the timing and need for ganciclovir therapy after liver transplantation.
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- 2001
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9. Liver transplantation for treatment of intrahepatic Osler's disease: first experiences.
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Pfitzmann R, Heise M, Langrehr JM, Jonas S, Steinmüller T, Podrabsky P, Ewert R, Settmacher U, Neuhaus R, and Neuhaus P
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- Aged, Arteriovenous Anastomosis pathology, Blood Pressure, Cardiac Output, Embolization, Therapeutic, Female, Hemodynamics, Hepatic Artery, Humans, Liver Diseases diagnostic imaging, Liver Function Tests, Middle Aged, Postoperative Complications, Pulmonary Artery, Renal Dialysis, Telangiectasia, Hereditary Hemorrhagic diagnostic imaging, Tomography, X-Ray Computed, Liver Diseases surgery, Liver Transplantation physiology, Telangiectasia, Hereditary Hemorrhagic surgery
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Background: Intrahepatic Osler's disease with multiple arteriovenous malformations and high intrahepatic shunting may lead to secondary pulmonary hypertension followed by right-heart stress and insufficiency. Until now, therapy with arterial embolization, banding, or ligation of the hepatic arteries is still limited and provides unsatisfactory long-term results. Liver transplantation offers another therapeutic option., Methods: We report on four patients with intrahepatic involvement of Osler's disease who were liver transplanted between 1995 and 1999. All patients suffered from restricted liver function and right-heart insufficiency with multiple cardiac decompensations. One patient received one course of embolization, and another received six courses of embolization and then banding of the main hepatic artery before transplantation. In both patients, the clinical symptoms improved for only a few months., Results: All patients had high degrees of intrahepatic arteriovenous shunting, and cardiac output measurements were between 8.0 to 13.3 L/min preoperatively. Preoperative mean pulmonary artery pressure was between 24 to 35 mmHg. After liver transplantation, cardiac output and right-heart diameter decreased or normalized and pulmonary pressure reached the normal range after 2 months. All patients received tacrolimus and steroids for primary immunosuppression. In one case, temporary hemodialysis was necessary for 2 weeks after transplantation, but renal function recovered completely. After follow-up time of 12 to 65 months, all patients had normal graft function and good cardiopulmonary condition., Conclusions: Indication for liver transplantation should be considered in patients with intrahepatic Osler's disease, high arteriovenous shunting with right-heart stress, and restricted liver function before irreversible fixed pulmonary hypertension leads to severe right-heart insufficiency or failure. Our therapeutic regimen of early liver transplantation in the case of intrahepatic Osler's disease in four patients has promising results.
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- 2001
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10. Preoperative contrast-enhanced MRI of the parathyroid glands in hyperparathyroidism.
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Lopez Hänninen E, Vogl TJ, Steinmüller T, Ricke J, Neuhaus P, and Felix R
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- Adenoma diagnosis, Contrast Media, Evaluation Studies as Topic, Female, Gadolinium DTPA, Humans, Hyperparathyroidism surgery, Male, Middle Aged, Parathyroid Neoplasms diagnosis, Preoperative Care, Sensitivity and Specificity, Hyperparathyroidism pathology, Magnetic Resonance Imaging, Parathyroid Glands pathology
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Rationale and Objectives: To evaluate the sensitivity of contrast-enhanced MRI in the preoperative detection of abnormal parathyroid glands in patients with clinical evidence of hyperparathyroidism., Methods: Twenty-eight patients with biochemical evidence of hyperparathyroidism underwent contrast-enhanced preoperative MRI of the parathyroid glands. Two blinded readers assessed the MR images by consensus, and MR results were subsequently correlated with those from surgery (location, diameter, weight) and histopathology., Results: MRI depicted 32 of 39 surgically proved abnormal parathyroid glands (sensitivity 82%; 95% confidence interval, 66%-92%), and 1 of 114 (0.9%) was incorrectly considered abnormal. All ectopic glands were correctly identified (2 mediastinal, 1 submandibular). Sensitivity was superior for adenomas but less for hyperplasia (adenomas 87%; 95% confidence interval, 67%-97%; hyperplasia 75%; 95% confidence interval, 47%-92%). Among all lesions, atypical signal characteristics on MRI were observed in 34% of lesions (9% hyperintense signals on T2- and T1-weighted images; 25% isointense signals on T2- and T1-weighted images), with improved lesion detection after contrast administration in 17% of lesions., Conclusions: MRI of the parathyroid glands presented a sensitive imaging modality, thus demonstrating its high potential to preoperatively detect abnormal glands. Moreover, in a minor proportion of patients with atypical parathyroid lesion characteristics, contrast administration may increase lesion detectability.
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- 2000
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11. Regulation of glucose tolerance in patients after liver transplantation: impact of cyclosporin versus tacrolimus therapy.
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Konrad T, Steinmüller T, Vicini P, Toffolo G, Grewerus D, Schüller A, Bechstein WO, Usadel KH, Cobelli C, and Neuhaus P
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- Adult, Biomarkers blood, C-Peptide blood, Female, Humans, Liver Transplantation immunology, Male, Proinsulin blood, Reference Values, Regression Analysis, Blood Glucose metabolism, Cyclosporine therapeutic use, Glucose Tolerance Test, Immunosuppressive Agents therapeutic use, Insulin blood, Liver Transplantation physiology, Tacrolimus therapeutic use
- Abstract
Background: We investigated the factors regulating glucose homeostasis in 10 healthy (control) subjects, as well as in stable, long-term, liver-grafted patients receiving monotherapy in the form of either cyclosporin A (n=10) or tacrolimus (n=10)., Methods: We measured insulin sensitivity, first- and second-phase insulin secretion, with a minimal modeling technique based on the analysis of glucose, insulin, and C-peptide profiles during frequently sampled intravenous glucose tolerance tests (FSIGTT). Proinsulin levels, as a marker of beta-cell dysfunction, were measured in the fasting state and during FSIGTT., Results: Glucose and insulin concentrations before and after glucose loading did not differ in liver transplant patients and in control subjects. Fasting C-peptide levels in both liver-grafted groups were higher than in healthy subjects and remained elevated during FSIGTT (P<0.05). Intravenous glucose tolerance [(K(G)), i.e. the slope of the regression of logarithm of the blood glucose concentrations vs. time], insulin sensitivity, and first-phase insulin secretion did not differ in liver-grafted groups and healthy subjects. Second-phase insulin secretion was about 56% higher in liver-grafted patients than in controls (P<0.05). Body mass index was the overall determinant of insulin sensitivity in all groups., Conclusions: Long-term monotherapy with cyclosporin A or tacrolimus has no deleterious effects on insulin sensitivity, first-phase insulin secretion, and insulin synthesis in liver transplant patients. Normal insulin sensitivity (posthepatic insulin effect) and enhanced second-phase insulin secretion (prehepatic insulin) point to an accelerated hepatic insulin clearance rate in liver transplant patients. Increased hepatic insulin clearance is compensated by enhanced insulin secretion, indicating that insulin clearance is the major determinant of pancreatic function in liver-grafted patients.
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- 2000
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12. A prospective randomized trial comparing interleukin-2 receptor antibody versus antithymocyte globulin as part of a quadruple immunosuppressive induction therapy following orthotopic liver transplantation.
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Langrehr JM, Nüssler NC, Neumann U, Guckelberger O, Lohmann R, Radtke A, Jonas S, Klupp J, Steinmüller T, Lobeck H, Meuer S, Schlag H, Lemmens HP, Knoop M, Keck H, Bechstein WO, and Neuhaus P
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- Adult, Animals, Cytomegalovirus Infections complications, Cytomegalovirus Infections mortality, Graft Rejection mortality, Humans, Mice, Pneumonia complications, Pneumonia mortality, Prospective Studies, Antibodies, Monoclonal therapeutic use, Antilymphocyte Serum therapeutic use, Immunosuppression Therapy, Immunosuppressive Agents therapeutic use, Liver Transplantation, Receptors, Interleukin-2 immunology
- Abstract
Background: Quadruple immunosuppressive induction therapy has been shown to markedly reduce the incidence of acute rejection episodes without increasing the incidence of infectious complications after liver transplantation. However, the use of polyclonal antibody preparations (e.g. antithymocyte globulin [ATG]) is associated with side effects such as fever and tachycardia. To evaluate the efficacy and the safety of a monoclonal antibody directed against the interleukin-2 receptor (BT563) in comparison with ATG as part of a quadruple induction regimen, a prospective, randomized study was conducted., Methods: Eighty consecutive adult recipients of primary orthotopic liver transplants were randomized to receive either BT563 (10 mg/day; days 0-12; n=39) or ATG (5 mg/kg/day; days 0-6; n=41) in addition to the standard immunosuppressive protocol consisting of cyclosporine, and prednisolone, and azathioprine., Results: Patients treated with BT563 had a significantly lower incidence of steroid-sensitive rejection episodes (3 vs. 11; P<0.025) and also significantly fewer drug-related side effects (4 vs. 18, P<0.038) when compared with patients treated with ATG. The incidence of infectious complications was not different between the two groups. Patient survival did not differ significantly between the two groups (84.6% at 1, 2, and 3 years in the BT563 group and 90.2% at 1 year and 87.8% at 2 and 3 years for the ATG group). Analysis of graft function showed an advantage for the BT563 group in terms of postoperative bilirubin levels. However, no differences were observed in long-term follow-up between the two groups., Conclusions: 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.
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- 1997
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13. Cytokine pattern during rejection and infection after liver transplantation--improvements in postoperative monitoring?
- Author
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Platz KP, Mueller AR, Rossaint R, Steinmüller T, Lemmens HP, Lobeck H, and Neuhaus P
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- Alanine Transaminase blood, Aspartate Aminotransferases blood, Bacterial Infections etiology, Bacterial Infections mortality, Bilirubin blood, Biopterins analogs & derivatives, Biopterins blood, C-Reactive Protein analysis, Graft Rejection epidemiology, Graft Rejection mortality, Humans, Incidence, Interleukin-10 blood, Interleukin-8 blood, Linear Models, Liver Transplantation adverse effects, Mycoses etiology, Neopterin, Prospective Studies, Receptors, Interleukin-2 blood, Receptors, Tumor Necrosis Factor blood, Solubility, Cytokines physiology, Graft Rejection metabolism, Liver Transplantation immunology
- Abstract
Despite improvements in immunosuppression, rejection occurs in 50% of liver transplant patients and may cause significant morbidity. The most frequent cause of death after liver transplantation is severe infection. Determination of the cytokine network may lead to earlier detection of patients at risk for severe rejection and infection. For this purpose, 81 patients with 85 liver transplants were monitored for cytokines and neopterin on a daily basis. During the first postoperative month, 28 patients (34.6%) developed acute rejection; 14 patients were successfully treated with methylprednisolone (steroid-sensitive rejection), while 14 patients required additional treatment with FK506 and OKT3 (steroid-resistant rejection). Ten patients developed severe infections, and 11 patients experienced asymptomatic cholangitis. Patients with an uneventful postoperative course (n=37) were the control group. One-year patient survival was 88.9%: 1 patient died because of chronic rejection and Pseudomonas urosepsis; a further 4 patients died of aspergillus pneumonia and bacterial sepsis. Soluble TNF-RII, sIL-2R-, and IL-10 levels were significantly elevated 3 days prior to or at the onset of acute steroid-resistant rejection (P < or = 0.01 versus steroid-sensitive rejection and on uneventful postoperative course). An increase in IL-8, neopterin, and sTNF-RII was indicative of severe infection 3 days prior to onset of infection. In this group of patients, a simultaneous increase in IL-10 indicated a lethal outcome of severe infection. During the second week of acute steroid-resistant rejection and lethal infection, a significant rise in IL-1beta, IFN-gamma, and IL-6 was observed (P < or = 0.01 versus control groups). The different patterns in neopterin- and cytokine-increase could differentiate between severe rejection and severe infection. Furthermore, the increase in these parameters indicated severe rejection--i.e., steroid resistance at the onset of acute rejection--which could prompt us to initiate rescue therapy immediately. The ability to detect patients at risk for severe or lethal infection may result in intensified infectious screening and more aggressive antiinfectious treatment. Therefore, routine monitoring of these parameters may lead to changes in therapeutic management of severe acute rejection and infection after liver transplantation.
- Published
- 1996
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14. The effect of FK506 versus cyclosporine on glucose and lipid metabolism--a randomized trial.
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Steinmüller TM, Gräf KJ, Schleicher J, Leder K, Bechstein WO, Mueller AR, Dette K, Schulz E, and Neuhaus P
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- Adolescent, Adult, Aged, Cholesterol blood, Female, Glucagon blood, Glucose Tolerance Test, Humans, Insulin blood, Male, Middle Aged, Prospective Studies, Triglycerides blood, Blood Glucose analysis, Cyclosporine pharmacology, Lipids blood, Liver Transplantation, Tacrolimus pharmacology
- Abstract
In order to evaluate the effect of cyclosporine (CsA) versus FK506 on glucose and lipid metabolism, an oral glucose tolerance test (OGTT) was performed in 101 patients after orthotopic liver transplantation (OLT) (mean interval after OLT: 511 days). The liver graft recipients had been randomized prospectively to two groups prior to OLT to receive either immunosuppression with CsA, azathioprine, and corticosteroids (CsA group) or FK506 and corticosteroids (FK group). Along with the OGTT, serum insulin, insulin C-peptide and glucagon as well as serum lipids were monitored. There was no statistically significant difference in the occurrence of impaired glucose tolerance (IGT) or manifest diabetes mellitus disease between the two groups. In fact, not a single patient developed new-onset diabetes in any group. In male and female patients, serum levels of cholesterol and triglycerides increased significantly under FK506 and CsA treatment after OLT. Cholesterol was significantly higher in the CsA group in men, in women this was marked, but not significant. While triglycerides were significantly higher in women on CsA treatment, there was no such difference in men. In conclusion, both CsA and FK506 proved to have similar effects on glucose metabolism, while there was a different spectrum of serum lipid alterations.
- Published
- 1994
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