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3. A paired-kidney allocation study found superior survival with HLA-DR compatible kidney transplants in the Eurotransplant Senior Program

Author

Fijter, J. de, Dreyer, G., Mallat, M., Budde, K., Pratschke, J., Klempnauer, J., Zeier, M., Arns, W., Hugo, C., Rump, L.C., Hauser, I., Schenker, P., Schiffer, M., Grimm, M.O., Kliem, V., Olbricht, C.J., Pisarski, P., Banas, B., Suwelack, B., Hakenberg, O., Berlakovich, G., Schneeberger, S., Wetering, J. van de, Berger, S., Bemelman, F., Kuypers, D., Heidt, S., Rahmel, A., Claas, F., Peeters, P., Oberbauer, R., Hilbrands, L.B., Heemann, U., Krämer, B.K., Fijter, J. de, Dreyer, G., Mallat, M., Budde, K., Pratschke, J., Klempnauer, J., Zeier, M., Arns, W., Hugo, C., Rump, L.C., Hauser, I., Schenker, P., Schiffer, M., Grimm, M.O., Kliem, V., Olbricht, C.J., Pisarski, P., Banas, B., Suwelack, B., Hakenberg, O., Berlakovich, G., Schneeberger, S., Wetering, J. van de, Berger, S., Bemelman, F., Kuypers, D., Heidt, S., Rahmel, A., Claas, F., Peeters, P., Oberbauer, R., Hilbrands, L.B., Heemann, U., and Krämer, B.K.

Abstract

Item does not contain fulltext, The Eurotransplant Senior Program (ESP) has expedited the chance for elderly patients with kidney failure to receive a timely transplant. This current study evaluated survival parameters of kidneys donated after brain death with or without matching for HLA-DR antigens. This cohort study evaluated the period within ESP with paired allocation of 675 kidneys from donors 65 years and older to transplant candidates 65 years and older, the first kidney to 341 patients within the Eurotransplant Senior DR-compatible Program and 334 contralateral kidneys without (ESP) HLA-DR antigen matching. We used Kaplan-Meier estimates and competing risk analysis to assess all cause mortality and kidney graft failure, respectively. The log-rank test and Cox proportional hazards regression were used for comparisons. Within ESP, matching for HLA-DR antigens was associated with a significantly lower five-year risk of mortality (hazard ratio 0.71; 95% confidence interval 0.53-0.95) and significantly lower cause-specific hazards for kidney graft failure and return to dialysis at one year (0.55; 0.35-0.87) and five years (0.73; 0.53-0.99) post-transplant. Allocation based on HLA-DR matching resulted in longer cold ischemia (mean difference 1.00 hours; 95% confidence interval: 0.32-1.68) and kidney offers with a significantly shorter median dialysis vintage of 2.4 versus 4.1 yrs. in ESP without matching. Thus, our allocation based on HLA-DR matching improved five-year patient and kidney allograft survival. Hence, our paired allocation study suggests a superior outcome of HLA-DR matching in the context of old-for-old kidney transplantation.

Published
2023

5. Improved Survival in Liver Transplant Recipients Receiving Prolonged-Release Tacrolimus in the European Liver Transplant Registry

Author

Adam, R., Karam, V., Delvart, V., Trunečka, P., Samuel, D., Bechstein, W.O., Němec, P., Tisone, G., Klempnauer, J., Rossi, M., Rummo, O.O., Dokmak, S., Krawczyk, M., Pratschke, J., Kollmar, O., Boudjema, K., Colledan, M., Ericzon, B.G., Mantion, G., Baccarani, U., Neuhaus, P., Paul, A., Bachellier, P., Zamboni, F., Hanvesakul, R., and Muiesan, P.

Published
2015
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6. Leberchirurgie

Author

Schrem, H., Bektas, H., Klempnauer, J., Bauch, J., editor, Bruch, H.-P., editor, Heberer, J., editor, and Jähne, J., editor

Published
2010
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8. Hepatocellular carcinoma progression during bridging before liver transplantation

Author

Renner, P, Da Silva, T, Schnitzbauer, A, Verloh, N, Schlitt, H, Geissler, E, Zulke, C, Lamby, P, Proneth, A, Duvoux, C, Burra, P, Jauch, K, Rentsch, M, Ganten, T, Schmidt, J, Settmacher, U, Heise, M, Rossi, G, Cillo, U, Kneteman, N, Adam, R, Van Hoek, B, Bachellier, P, Wolf, P, Rostaing, L, Bechstein, W, Rizell, M, Powell, J, Hidalgo, E, Gugenheim, J, Wolters, H, Brockmann, J, Roy, A, Mutzbauer, I, Schlitt, A, Beckebaum, S, Graeb, C, Nadalin, S, Valente, U, Sanchez Turrion, V, Jamieson, N, Scholz, T, Colledan, M, Fandrich, F, Becker, T, Soderdahl, G, Chazouilleres, O, Makisalo, H, Pageaux, G, Steininger, R, Soliman, T, De Jong, K, Pirenne, J, Margreiter, R, Pratschke, J, Pinna, A, Hauss, J, Schreiber, S, Strasser, S, Klempnauer, J, Troisi, R, Bhoori, S, Lerut, J, Bilbao, I, Klein, C, Konigsrainer, A, Otto, G, Mazzaferro, V, Neuhaus, P, Renner P., Da Silva T., Schnitzbauer A. A., Verloh N., Schlitt H. J., Geissler E. K., Zulke C., Lamby P. E., Proneth A., Duvoux C., Burra P., Jauch K. -W., Rentsch M., Ganten T. M., Schmidt J., Settmacher U., Heise M., Rossi G., Cillo U., Kneteman N., Adam R., Van Hoek B., Bachellier P., Wolf P., Rostaing L., Bechstein W. O., Rizell M., Powell J., Hidalgo E., Gugenheim J., Wolters H., Brockmann J., Roy A., Mutzbauer I., Schlitt A., Beckebaum S., Graeb C., Nadalin S., Valente U., Sanchez Turrion V., Jamieson N., Scholz T., Colledan M., Fandrich F., Becker T., Soderdahl G., Chazouilleres O., Makisalo H., Pageaux G. -P., Steininger R., Soliman T., De Jong K. P., Pirenne J., Margreiter R., Pratschke J., Pinna A. D., Hauss J., Schreiber S., Strasser S., Klempnauer J., Troisi R. I., Bhoori S., Lerut J., Bilbao I., Klein C. G., Konigsrainer A., Otto G., Mazzaferro V., Neuhaus P., Renner, P, Da Silva, T, Schnitzbauer, A, Verloh, N, Schlitt, H, Geissler, E, Zulke, C, Lamby, P, Proneth, A, Duvoux, C, Burra, P, Jauch, K, Rentsch, M, Ganten, T, Schmidt, J, Settmacher, U, Heise, M, Rossi, G, Cillo, U, Kneteman, N, Adam, R, Van Hoek, B, Bachellier, P, Wolf, P, Rostaing, L, Bechstein, W, Rizell, M, Powell, J, Hidalgo, E, Gugenheim, J, Wolters, H, Brockmann, J, Roy, A, Mutzbauer, I, Schlitt, A, Beckebaum, S, Graeb, C, Nadalin, S, Valente, U, Sanchez Turrion, V, Jamieson, N, Scholz, T, Colledan, M, Fandrich, F, Becker, T, Soderdahl, G, Chazouilleres, O, Makisalo, H, Pageaux, G, Steininger, R, Soliman, T, De Jong, K, Pirenne, J, Margreiter, R, Pratschke, J, Pinna, A, Hauss, J, Schreiber, S, Strasser, S, Klempnauer, J, Troisi, R, Bhoori, S, Lerut, J, Bilbao, I, Klein, C, Konigsrainer, A, Otto, G, Mazzaferro, V, Neuhaus, P, Renner P., Da Silva T., Schnitzbauer A. A., Verloh N., Schlitt H. J., Geissler E. K., Zulke C., Lamby P. E., Proneth A., Duvoux C., Burra P., Jauch K. -W., Rentsch M., Ganten T. M., Schmidt J., Settmacher U., Heise M., Rossi G., Cillo U., Kneteman N., Adam R., Van Hoek B., Bachellier P., Wolf P., Rostaing L., Bechstein W. O., Rizell M., Powell J., Hidalgo E., Gugenheim J., Wolters H., Brockmann J., Roy A., Mutzbauer I., Schlitt A., Beckebaum S., Graeb C., Nadalin S., Valente U., Sanchez Turrion V., Jamieson N., Scholz T., Colledan M., Fandrich F., Becker T., Soderdahl G., Chazouilleres O., Makisalo H., Pageaux G. -P., Steininger R., Soliman T., De Jong K. P., Pirenne J., Margreiter R., Pratschke J., Pinna A. D., Hauss J., Schreiber S., Strasser S., Klempnauer J., Troisi R. I., Bhoori S., Lerut J., Bilbao I., Klein C. G., Konigsrainer A., Otto G., Mazzaferro V., and Neuhaus P.

Abstract

Background: Recipient selection for liver transplantation in hepatocellular carcinoma (HCC) is based primarily on criteria affecting the chance of long-term success. Here, the relationship between pretransplant bridging therapy and long-term survival was investigated in a subgroup analysis of the SiLVER Study. Methods: Response to bridging, as defined by comparison of imaging at the time of listing and post-transplant pathology report, was categorized into controlled versus progressive disease (more than 20 per cent tumour growth or development of new lesions). Results: Of 525 patients with HCC who had liver transplantation, 350 recipients underwent pretransplant bridging therapy. Tumour progression despite bridging was an independent risk factor affecting overall survival (hazard ratio 1.80; P=0.005). For patients within the Milan criteria (MC) at listing, mean overall survival was longer for those with controlled versus progressive disease (6.8 versus 5.8 years; P<0.001). Importantly, patients with HCCs outside the MC that were downsized to within the MC before liver transplantation had poor outcomes compared with patients who never exceeded the MC (mean overall survival 6.2 versus 6.6 years respectively; P=0.030). Conclusion: Patients with HCCs within the MC that did not show tumour progression under locoregional therapy had the best outcomes after liver transplantation. Downstaging into the limits of the MC did not improve the probability of survival. Prognostic factors determining the long-term success of liver transplantation in patients with hepatocellular carcinoma are still under discussion. A subgroup analysis of the SiLVER trial showed that disease control under bridging therapy is strongly associated with improved prognosis in terms of overall survival. However, in tumours exceeding the limits of the Milan criteria, downstaging did not restore the probability of survival compared with that of patients within the Milan criteria.

Published
2021

11. Pankreaskarzinom

Author

Strumberg, D., Oettle, H., Heinemann, V., Wilkowski, R., Klempnauer, J., Arnold, D., Schmoll, Hans-Joachim, editor, Höffken, Klaus, editor, and Possinger, Kurt, editor

Published
2006
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12. mTOR Inhibition Is Most Beneficial After Liver Transplantation for Hepatocellular Carcinoma in Patients With Active Tumors

Author

Schnitzbauer, A, Filmann, N, Adam, R, Bachellier, P, Bechstein, W, Becker, T, Bhoori, S, Bilbao, I, Brockmann, J, Burra, P, Chazoullieres, O, Cillo, U, Colledan, M, Duvoux, C, Ganten, T, Gugenheim, J, Heise, M, van Hoek, B, Jamieson, N, de Jong, K, Klein, C, Klempnauer, J, Kneteman, N, Lerut, J, Makisalo, H, Mazzaferro, V, Mirza, D, Nadalin, S, Neuhaus, P, Pageaux, G, Pinna, A, Pirenne, J, Pratschke, J, Powel, J, Rentsch, M, Rizell, M, Rossi, G, Rostaing, L, Roy, A, Scholz, T, Settmacher, U, Soliman, T, Strasser, S, Soderdahl, G, Troisi, R, Turrion, V, Schlitt, H, Geissler, E, Schnitzbauer AA, Filmann N, Adam RP, Bachellier P, Bechstein WO, Becker T, Bhoori S, Bilbao I, Brockmann J, Burra P, Chazoullieres O, Cillo U, Colledan M, Duvoux C, Ganten TM, Gugenheim J, Heise M, van Hoek B, Jamieson N, de Jong KP, Klein CG, Klempnauer J, Kneteman N, Lerut J, Makisalo H, Mazzaferro V, Mirza DF, Nadalin S, Neuhaus P, Pageaux GP, Pinna AD, Pirenne J, Pratschke J, Powel J, Rentsch M, Rizell M, Rossi G, Rostaing L, Roy AP, Scholz T, Settmacher U, Soliman T, Strasser S, Soderdahl G, Troisi RI, Turrion VS, Schlitt HJ, Geissler EK, Schnitzbauer, A, Filmann, N, Adam, R, Bachellier, P, Bechstein, W, Becker, T, Bhoori, S, Bilbao, I, Brockmann, J, Burra, P, Chazoullieres, O, Cillo, U, Colledan, M, Duvoux, C, Ganten, T, Gugenheim, J, Heise, M, van Hoek, B, Jamieson, N, de Jong, K, Klein, C, Klempnauer, J, Kneteman, N, Lerut, J, Makisalo, H, Mazzaferro, V, Mirza, D, Nadalin, S, Neuhaus, P, Pageaux, G, Pinna, A, Pirenne, J, Pratschke, J, Powel, J, Rentsch, M, Rizell, M, Rossi, G, Rostaing, L, Roy, A, Scholz, T, Settmacher, U, Soliman, T, Strasser, S, Soderdahl, G, Troisi, R, Turrion, V, Schlitt, H, Geissler, E, Schnitzbauer AA, Filmann N, Adam RP, Bachellier P, Bechstein WO, Becker T, Bhoori S, Bilbao I, Brockmann J, Burra P, Chazoullieres O, Cillo U, Colledan M, Duvoux C, Ganten TM, Gugenheim J, Heise M, van Hoek B, Jamieson N, de Jong KP, Klein CG, Klempnauer J, Kneteman N, Lerut J, Makisalo H, Mazzaferro V, Mirza DF, Nadalin S, Neuhaus P, Pageaux GP, Pinna AD, Pirenne J, Pratschke J, Powel J, Rentsch M, Rizell M, Rossi G, Rostaing L, Roy AP, Scholz T, Settmacher U, Soliman T, Strasser S, Soderdahl G, Troisi RI, Turrion VS, Schlitt HJ, and Geissler EK

Abstract

Objective: The aim of this study was to evaluate the survival benefit of sirolimus in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC) (exploratory analysis of the SiLVER-trial). Summary and Background Data: Patients receiving LT) for HCC are at a high risk for tumor recurrence. Calcineurin inhibitors have shown evidence to promote cancer growth, whereas mammalian target of rapamycin (mTOR) inhibitors like sirolimus have anticancer effects. In the SiLVER-trial (Clinicaltrials.gov:NCT00355862), the effect of sirolimus on the recurrence of HCC after LTwas investigated in a prospective randomized trial. Although the primary endpoint of improved disease-free survival (DFS) with sirolimus was not met, outcomes were improved for patients in the sirolimus-treatment arm in the first 3 to 5 years. To learn more about the key variables, a multivariate analysis was performed on the SiLVER-trial data. Patients and Methods: Data from 508 patients of the intention-to-treat analysis were included in exploratory univariate and multivariate models for overall survival (OS), DFS and a competing risk analysis for HCC recurrence. Results: Sirolimus use for >= 3 months after LT for HCC independently reduced the hazard for death in the multivariate analysis [hazard ratio (HR): 0.7 (95% confidence interval, CI: 0.52-0.96, P = 0.02). Most strikingly, patients with an alpha-fetoprotein (AFP) >= 10 ng/mL and having used sirolimus for >= 3 months, benefited most with regard to OS, DFS, and HCC-recurrence (HR: 0.49- 0.59, P = 0.0079- 0.0245). Conclusions: mTOR-inhibitor treatment with sirolimus for >= 3 months improves outcomes in LT for HCC, especially in patients with AFP-evidence of higher tumor activity, advocating particularly for mTOR inhibitor use in this subgroup of patients. Clinical Trial Registration: EudraCT: 2005-005362-36 Clinicaltrials.gov: NCT00355862.

Published
2020

13. HCC recurrence in HCV-infected patients after liver transplantation: SiLVER Study reveals benefits of sirolimus in combination with CNIs – a post-hoc analysis

Author

Werner, J, Hornung, M, Krah, R, Gotz, M, Schnitzbauer, A, Schlitt, H, Geissler, E, Zulke, C, Lamby, P, Proneth, A, Duvoux, C, Burra, P, Jauch, K, Rentsch, M, Ganten, T, Schmidt, J, Settmacher, U, Heise, M, Rossi, G, Cillo, U, Kneteman, N, Adam, R, Hoek, B, Bachellier, P, Wolf, P, Rostaing, L, Bechstein, W, Rizell, M, Powell, J, Hidalgo, E, Gugenheim, J, Wolters, H, Brockmann, J, Roy, A, Mutzbauer, I, Schlitt, A, Beckebaum, S, Graeb, C, Nadalin, S, Valente, U, Turrion, V, Jamieson, N, Scholz, T, Colledan, M, Fandrich, F, Becker, T, Soderdahl, G, Chazouilleres, O, Makisalo, H, Pageaux, G, Steininger, R, Soliman, T, Jong, K, Pirenne, J, Margreiter, R, Pratschke, J, Pinna, A, Hauss, J, Schreiber, S, Strasser, S, Klempnauer, J, Troisi, R, Bhoori, S, Lerut, J, Bilbao, I, Klein, C, Konigsrainer, A, Otto, G, Mazzaferro, V, Neuhaus, P, Werner J. M., Hornung M., Krah R., Gotz M., Schnitzbauer A. A., Schlitt H. J., Geissler E. K., Zulke C., Lamby P. E., Proneth A., Duvoux C., Burra P., Jauch K. -W., Rentsch M., Ganten T. M., Schmidt J., Settmacher U., Heise M., Rossi G., Cillo U., Kneteman N., Adam R., Hoek B., Bachellier P., Wolf P., Rostaing L., Bechstein W. O., Rizell M., Powell J., Hidalgo E., Gugenheim J., Wolters H., Brockmann J., Roy A., Mutzbauer I., Schlitt A., Beckebaum S., Graeb C., Nadalin S., Valente U., Turrion V. S., Jamieson N., Scholz T., Colledan M., Fandrich F., Becker T., Soderdahl G., Chazouilleres O., Makisalo H., Pageaux G. -P., Steininger R., Soliman T., Jong K. P., Pirenne J., Margreiter R., Pratschke J., Pinna A. D., Hauss J., Schreiber S., Strasser S., Klempnauer J., Troisi R. I., Bhoori S., Lerut J., Bilbao I., Klein C. G., Konigsrainer A., Otto G., Mazzaferro V., Neuhaus P., Werner, J, Hornung, M, Krah, R, Gotz, M, Schnitzbauer, A, Schlitt, H, Geissler, E, Zulke, C, Lamby, P, Proneth, A, Duvoux, C, Burra, P, Jauch, K, Rentsch, M, Ganten, T, Schmidt, J, Settmacher, U, Heise, M, Rossi, G, Cillo, U, Kneteman, N, Adam, R, Hoek, B, Bachellier, P, Wolf, P, Rostaing, L, Bechstein, W, Rizell, M, Powell, J, Hidalgo, E, Gugenheim, J, Wolters, H, Brockmann, J, Roy, A, Mutzbauer, I, Schlitt, A, Beckebaum, S, Graeb, C, Nadalin, S, Valente, U, Turrion, V, Jamieson, N, Scholz, T, Colledan, M, Fandrich, F, Becker, T, Soderdahl, G, Chazouilleres, O, Makisalo, H, Pageaux, G, Steininger, R, Soliman, T, Jong, K, Pirenne, J, Margreiter, R, Pratschke, J, Pinna, A, Hauss, J, Schreiber, S, Strasser, S, Klempnauer, J, Troisi, R, Bhoori, S, Lerut, J, Bilbao, I, Klein, C, Konigsrainer, A, Otto, G, Mazzaferro, V, Neuhaus, P, Werner J. M., Hornung M., Krah R., Gotz M., Schnitzbauer A. A., Schlitt H. J., Geissler E. K., Zulke C., Lamby P. E., Proneth A., Duvoux C., Burra P., Jauch K. -W., Rentsch M., Ganten T. M., Schmidt J., Settmacher U., Heise M., Rossi G., Cillo U., Kneteman N., Adam R., Hoek B., Bachellier P., Wolf P., Rostaing L., Bechstein W. O., Rizell M., Powell J., Hidalgo E., Gugenheim J., Wolters H., Brockmann J., Roy A., Mutzbauer I., Schlitt A., Beckebaum S., Graeb C., Nadalin S., Valente U., Turrion V. S., Jamieson N., Scholz T., Colledan M., Fandrich F., Becker T., Soderdahl G., Chazouilleres O., Makisalo H., Pageaux G. -P., Steininger R., Soliman T., Jong K. P., Pirenne J., Margreiter R., Pratschke J., Pinna A. D., Hauss J., Schreiber S., Strasser S., Klempnauer J., Troisi R. I., Bhoori S., Lerut J., Bilbao I., Klein C. G., Konigsrainer A., Otto G., Mazzaferro V., and Neuhaus P.

Abstract

Factors affecting outcomes in liver transplant (LTx) recipients with hepatocellular carcinoma (HCC) and hepatitis C viral (HCV) infection include the choice of immunosuppression. Here, we analyzed the HCV+ subgroup of patients from the randomized controlled, international SiLVER Study. We performed a post hoc analysis of 166 HCV+ SiLVER Study patients regarding HCC outcome after LTx. Control patients (group A: n = 88) received mTOR inhibitor (mTORi)-free, calcineurin inhibitor (CNI)-based versus sirolimus-based immunosuppression (group B: n = 78). We found no significant difference regarding HCV-RNA titers between group A and B. Since no effect in group B could be due to variable sirolimus dosing, we split group B into patients receiving sirolimus-based immunosuppression + CNIs for >50% (B1; n = 44) or <50% (B2; n = 34) of the time. While there remained no difference in HCV-RNA titer between groups, HCC recurrence-free survival in group B1 (81.8%) was markedly better versus both group A (62.7%; P = 0.0136) and group B2 (64.7%; P = 0.0326); Interestingly, further subgroup analysis revealed an increase (P = 0.0012) in liver enzyme values in group B2. Taken together, in HCV-infected patients with HCC and LTx, mTORi immunosuppression + CNIs yields excellent outcomes. Unexpectedly, higher levels of liver inflammation and poorer outcomes occur with mTORi monotherapy in the HCV+ subgroup.

Published
2020

15. European Liver Transplant Registry: Donor and transplant surgery aspects of 16,641 liver transplantations in children

Author

de Ville de Goyet, J, Baumann, U, Karam, V, Adam, R, Nadalin, S, Heaton, N, Reding, R, Branchereau, S, Mirza, D, Klempnauer, J, Fischer, L, Kalicinski, P, Colledan, M, Lopez Santamaria, M, de Kleine, R, Chardot, C, Yilmaz, S, Kilic, M, Boillot, O, di Francesco, F, Polak, W, Verkade, H, de Ville de Goyet, Jean, Baumann, Ulrich, Karam, Vincent, Adam, René, Nadalin, Silvio, Heaton, Nigel, Reding, Raymond, Branchereau, Sophie, Mirza, Darius, Klempnauer, Jürgen L, Fischer, Lutz, Kalicinski, Piotr, Colledan, Michele, Lopez Santamaria, Manuel, de Kleine, Ruben H, Chardot, Christophe, Yilmaz, Sezai, Kilic, Murat, Boillot, Olivier, di Francesco, Fabrizio, Polak, Wojciech G, Verkade, Henkjan J, de Ville de Goyet, J, Baumann, U, Karam, V, Adam, R, Nadalin, S, Heaton, N, Reding, R, Branchereau, S, Mirza, D, Klempnauer, J, Fischer, L, Kalicinski, P, Colledan, M, Lopez Santamaria, M, de Kleine, R, Chardot, C, Yilmaz, S, Kilic, M, Boillot, O, di Francesco, F, Polak, W, Verkade, H, de Ville de Goyet, Jean, Baumann, Ulrich, Karam, Vincent, Adam, René, Nadalin, Silvio, Heaton, Nigel, Reding, Raymond, Branchereau, Sophie, Mirza, Darius, Klempnauer, Jürgen L, Fischer, Lutz, Kalicinski, Piotr, Colledan, Michele, Lopez Santamaria, Manuel, de Kleine, Ruben H, Chardot, Christophe, Yilmaz, Sezai, Kilic, Murat, Boillot, Olivier, di Francesco, Fabrizio, Polak, Wojciech G, and Verkade, Henkjan J

Abstract

Background and Aims: The European Liver Transplant Registry (ELTR) has collected data on liver transplant procedures performed in Europe since 1968. Approach and Results: Over a 50-year period (1968–2017), clinical and laboratory data were collected from 133 transplant centers and analyzed retrospectively (16,641 liver transplants in 14,515 children). Data were analyzed according to three successive periods (A, before 2000; B, 2000–2009; and C, since 2010), studying donor and graft characteristics and graft outcome. The use of living donors steadily increased from A to C (A, n = 296 [7%]; B, n = 1131 [23%]; and C, n = 1985 [39%]; p = 0.0001). Overall, the 5-year graft survival rate has improved from 65% in group A to 75% in group B (p < 0.0001) and to 79% in group C (B versus C, p < 0.0001). Graft half-life was 31 years, overall; it was 41 years for children who survived the first year after transplant. The late annual graft loss rate in teenagers is higher than that in children aged <12 years and similar to that of young adults. No evidence for accelerated graft loss after age 18 years was found. Conclusions: Pediatric liver transplantation has reached a high efficacy as a cure or treatment for severe liver disease in infants and children. Grafts that survived the first year had a half-life similar to standard human half-life. Transplantation before or after puberty may be the pivot-point for lower long-term outcome in children. Further studies are necessary to revisit some old concepts regarding transplant benefit (survival time) for small children, the role of recipient pathophysiology versus graft aging, and risk at transition to adult age.

Published
2022

19. Analkarzinom

Author

Dienes, H. P., Klempnauer, J., Südhoff, T., Petrasch, S., Adler, G., editor, Beglinger, C., editor, Manns, M. P., editor, Müller-Lissner, S., editor, and Schmiegel, W., editor

Published
2000
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20. Kolontumoren

Author

Dienes, H. P., Klempnauer, J., Petrasch, S., Wengler-Becker, U., Schmiegel, W., Adler, G., editor, Beglinger, C., editor, Manns, M. P., editor, Müller-Lissner, S., editor, and Schmiegel, W., editor

Published
2000
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21. Neoplasien der Leber und Gallenwege

Author

Graeven, U., Klempnauer, J., Dienes, H. P., Schmiegel, W., Adler, G., editor, Beglinger, C., editor, Manns, M. P., editor, Müller-Lissner, S., editor, and Schmiegel, W., editor

Published
2000
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22. Magentumoren

Author

Dienes, H. P., Klempnauer, J., Petrasch, S., Wengler-Becker, U., Adler, G., editor, Beglinger, C., editor, Manns, M. P., editor, Müller-Lissner, S., editor, and Schmiegel, W., editor

Published
2000
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23. Ösophagustumoren

Author

Dienes, H. P., Wengler-Becker, U., Klempnauer, J., Südhoff, T., Petrasch, S., Adler, G., editor, Beglinger, C., editor, Manns, M. P., editor, Müller-Lissner, S., editor, and Schmiegel, W., editor

Published
2000
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26. A Randomized, Controlled Study to Assess the Conversion From Calcineurin-Inhibitors to Everolimus After Liver Transplantation—PROTECT

Author

Fischer, L., Klempnauer, J., Beckebaum, S., Metselaar, H.J., Neuhaus, P., Schemmer, P., Settmacher, U., Heyne, N., Clavien, P-A., Muehlbacher, F., Morard, I., Wolters, H., Vogel, W., Becker, T., Sterneck, M., Lehner, F., Klein, C., Kazemier, G., Pascher, A., Schmidt, J., Rauchfuss, F., Schnitzbauer, A., Nadalin, S., Hack, M., Ladenburger, S., and Schlitt, H.J.

Published
2012
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28. Hepatocellular carcinoma progression during bridging before liver transplantation

Author

Renner P., Da Silva T., Schnitzbauer A. A., Verloh N., Schlitt H. J., Geissler E. K., Zulke C., Lamby P. E., Proneth A., Duvoux C., Burra P., Jauch K. -W., Rentsch M., Ganten T. M., Schmidt J., Settmacher U., Heise M., Rossi G., Cillo U., Kneteman N., Adam R., Van Hoek B., Bachellier P., Wolf P., Rostaing L., Bechstein W. O., Rizell M., Powell J., Hidalgo E., Gugenheim J., Wolters H., Brockmann J., Roy A., Mutzbauer I., Schlitt A., Beckebaum S., Graeb C., Nadalin S., Valente U., Sanchez Turrion V., Jamieson N., Scholz T., Colledan M., Fandrich F., Becker T., Soderdahl G., Chazouilleres O., Makisalo H., Pageaux G. -P., Steininger R., Soliman T., De Jong K. P., Pirenne J., Margreiter R., Pratschke J., Pinna A. D., Hauss J., Schreiber S., Strasser S., Klempnauer J., Troisi R. I., Bhoori S., Lerut J., Bilbao I., Klein C. G., Konigsrainer A., Otto G., Mazzaferro V., Neuhaus P., Renner, P, Da Silva, T, Schnitzbauer, A, Verloh, N, Schlitt, H, Geissler, E, Zulke, C, Lamby, P, Proneth, A, Duvoux, C, Burra, P, Jauch, K, Rentsch, M, Ganten, T, Schmidt, J, Settmacher, U, Heise, M, Rossi, G, Cillo, U, Kneteman, N, Adam, R, Van Hoek, B, Bachellier, P, Wolf, P, Rostaing, L, Bechstein, W, Rizell, M, Powell, J, Hidalgo, E, Gugenheim, J, Wolters, H, Brockmann, J, Roy, A, Mutzbauer, I, Schlitt, A, Beckebaum, S, Graeb, C, Nadalin, S, Valente, U, Sanchez Turrion, V, Jamieson, N, Scholz, T, Colledan, M, Fandrich, F, Becker, T, Soderdahl, G, Chazouilleres, O, Makisalo, H, Pageaux, G, Steininger, R, Soliman, T, De Jong, K, Pirenne, J, Margreiter, R, Pratschke, J, Pinna, A, Hauss, J, Schreiber, S, Strasser, S, Klempnauer, J, Troisi, R, Bhoori, S, Lerut, J, Bilbao, I, Klein, C, Konigsrainer, A, Otto, G, Mazzaferro, V, Neuhaus, P, and Publica

Subjects
Male, Carcinoma, Hepatocellular, Time Factor, Waiting Lists, AcademicSubjects/MED00910, Prognosi, Risk Factor, Middle Aged, Liver Transplantation, Treatment Outcome, Liver Neoplasm, Disease Progression, Female, Original Article, Survival Analysi, Neoplasm Recurrence, Local, AcademicSubjects/MED00010, Multivariate Analysi, Human
Abstract

Background Recipient selection for liver transplantation in hepatocellular carcinoma (HCC) is based primarily on criteria affecting the chance of long-term success. Here, the relationship between pretransplant bridging therapy and long-term survival was investigated in a subgroup analysis of the SiLVER Study. Methods Response to bridging, as defined by comparison of imaging at the time of listing and post-transplant pathology report, was categorized into controlled versus progressive disease (more than 20 per cent tumour growth or development of new lesions). Results Of 525 patients with HCC who had liver transplantation, 350 recipients underwent pretransplant bridging therapy. Tumour progression despite bridging was an independent risk factor affecting overall survival (hazard ratio 1.80; P = 0.005). For patients within the Milan criteria (MC) at listing, mean overall survival was longer for those with controlled versus progressive disease (6.8 versus 5.8 years; P

Published
2021

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