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Biliary complications following liver transplantation: Singlecenter experience over three decades and recent risk factors

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World journal of Hepatology 2017年第3期9卷 147-154页

作者： Alexander Kaltenborn André Gutcke jill Gwiasda jürgen klempnauer Harald Schrem Department of Trauma and Orthopedic Surgery Federal Armed Forces Hospital Wester-stede Core Facility Quality Management and Health Tech-nology Assessment in Transplantation Integrated Research and Treatment Facility Transplantation (IFB-Tx)Hannover Medical School Department of General Visceral and Transplant Surgery Hannover Medical School

AIM To identify independent risk factors for biliary complications in a center with three decades of experience in liver *** A total of 1607 consecutive liver transplantations were analyzed in a retrospective study. Detailed subset analysis was performed in 417 patients, which have been transplanted since the introduction of Model of End-Stage Liver Disease(MELD)-based liver allocation. Risk factors for the onset of anastomotic biliary complications were identified with multivariable binary logisticregression analyses. The identified risk factors in regression analyses were compiled into a prognostic model. The applicability was evaluated with receiver operating characteristic curve analyses. Furthermore, Kaplan-Meier analyses with the log rank test were applied where appropriate. RESULTS Biliary complications were observed in 227 cases(14.1%). Four hundred and seventeen(26%) transplantations were performed after the introduction of MELD-based donor organ allocation. Since then, 21%(n = 89) of the patients suffered from biliary complications, which are further categorized into anastomotic bile leaks [46%(n = 41)], anastomotic strictures [25%(n = 22)], cholangitis [8%(n = 7)] and non-anastomotic strictures [3%(n = 3)]. The remaining 18%(n = 16) were not further classified. After adjustment for all univariably significant variables, the recipient MELD-score at transplantation(P = 0.006; OR = 1.035; 95%CI: 1.010-1.060), the development of hepatic artery thrombosis post-operatively(P = 0.019; OR = 3.543; 95%CI: 1.233-10.178), as well as the donor creatinine prior to explantation(P = 0.010; OR = 1.003; 95%CI: 1.001-1.006) were revealed as independent risk factors for biliary complications. The compilation of these identified risk factors into a prognostic model was shown to have good prognostic abilities in the investigated cohort with an area under the receiver operating curve of *** The parallel occurrence of high recipient MELD and imp

关键词： Biliary complications Liver transplantation Prognostic model Risk factors Multivariable analyses

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Prediction of survival after left-sided pancreatic resection for adenocarcinoma: Introduction of a new prognostic score

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Hepatobiliary & Pancreatic Diseases International 2019年第6期18卷 569-575页

作者： jill Gwiasda Zhi Qu Harald Schrem Felix Oldhafer Markus Winny jürgen klempnauer Gerrit Grannas Alexander Kaltenborn Transplant Center Hannover Medical SchoolCarl-Neuberg Str.130625 HannoverGermany Department of General Visceral and Transplant SurgeryHannover Medical SchoolHannoverGermany

Background:Due to the clinically unapparent course the entity of left-sided pancreatic adenocarcinoma is often diagnosed at advanced stages,resulting in small numbers of patients qualifying for *** study strives to develop a prognostic model for survival after left-sided pancreatic ***:A total of 54 patients were ***-and intra-operative predictive factors for 18-month mortality were identified with multivariable binary logistic regression analysis and compiled into a prognostic *** applicability was evaluated by assessment of the area under the receiver operating characteristic curve(AUROC).The model was internally validated applying a randomized backwards bootstrapping ***:The 18-month mortality rate was 74.1%(n=40).Mean survival was 19.1 months.A prognostic model for 18-month mortality after left sided-pancreatectomy showed an AUROC>0.800:18-month mortality risk in%=Exp(Y)/(1+Exp(Y))with y=-0.927+(1.724,if CA 19-9 elevated,otherwise 0)+(1.212×number of intra-operative transfused packed red blood cells)+(2.771,if prior abdominal surgery,otherwise 0)-(3.612,if gastric resection,otherwise 0)This model was internally validated in 40 randomized backwards bootstrapping steps with AUROCs ranging from 0.757 to ***:The 18-month mortality risk for patients after left-sided pancreatectomy for adenocarcinoma of the pancreatic body can be assessed with the number of intra-operatively transfused packed red blood cells,elevated CA 19-9 levels,additional gastric resection and prior abdominal surgeries in the patient’s history.

关键词： Pancreatic cancer Mortality Risk factors

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Hepatic encephalopathy before and neurological complications after liver transplantation have no impact on the employment status 1 year after transplantation

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World journal of Hepatology 2017年第10期9卷 519-532页

作者： Henning Pflugrad Anita B Tryc Annemarie Goldbecker Christian P Strassburg Hannelore Barg-Hock jürgen klempnauer Karin Weissenborn Department of Neurology Hannover Medical School Integrated Research and Treatment Centre Transplantation Department of Gastroenterology Hepatology and EndocrinologyHannover Medical School Department of Medicine I University Hospital Bonn Clinic for Visceral and Transplant Surgery Hannover Medical School

To investigate the impact of hepatic encephalopathy before orthotopic liver transplantation (OLT) and neurological complications after OLT on employment after OLT. METHODSOne hundred and fourteen patients with chronic liver disease aged 18-60 years underwent neurological examination to identify neurological complications, neuropsychological tests comprising the PSE-Syndrome-Test yielding the psychometric hepatic encephalopathy score, the critical flicker frequency and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), completed a questionnaire concerning their occupation and filled in the short form 36 (SF-36) to assess health-related quality of life before OLT and 12 mo after OLT, if possible. Sixty-eight (59.6%) patients were recruited before OLT, while on the waiting list for OLT at Hannover Medical School [age: 48.7 ± 10.2 years, 45 (66.2%) male], and 46 (40.4%) patients were included directly after OLT. RESULTSBefore OLT 43.0% of the patients were employed. The patients not employed before OLT were more often non-academics (employed: Academic/non-academic 16 (34.0%)/31 vs not employed 10 (17.6%)/52, P = 0.04), had more frequently a history of hepatic encephalopathy (HE) (yes/no; employed 15 (30.6%)/34 vs not employed 32 (49.2%)/33, P = 0.05) and achieved worse results in psychometric tests (RBANS sum score mean ± SD employed 472.1 ± 44.5 vs not employed 443.1 ± 56.7, P = 0.04) than those employed. Ten patients (18.2%), who were not employed before OLT, resumed work afterwards. The patients employed after OLT were younger [age median (range, min-max) employed 47 (42, 18-60) vs not employed 50 (31, 29-60), P = 0.01], achieved better results in the psychometric tests (RBANS sum score mean ± SD employed 490.7 ± 48.2 vs not employed 461.0 ± 54.5, P = 0.02) and had a higher health-related quality of life (SF 36 sum score mean ± SD employed 627.0 ± 138.1 vs not employed 433.7 ± 160.8; P < 0.001) compared to patients not employed after OLT.

关键词： Hepatic encephalopathy Employment Neurological complications Cognitive function Health-related quality of life Liver transplantation

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Myeloid sarcoma as a differential diagnosis of small bowel obstruction

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Case Reports in Clinical Medicine 2013年第2期2卷 173-176页

作者： Bastian Kettler Mahmoud Abbas Bastian Ringe Lothar Hambach jürgen klempnauer Michael Winkler Hans-Heinrich Kreipe Nikos Emmanouilidis Clinic for General- Abdominal- and Transplant-Surgery Medical School Hannover Hannover Germany Clinic for Haematology Medical School Hannover Hannover Germany Institute for Pathology Medical School Hannover Hannover Germany

We are presenting the case of a 42-year-old ?male patient, who was hospitalized due to an acute small bowel obstruction caused by a tissue mass of the mesentery. The patient reported that he had a history of a testicular tumour. For therapy of intestinal obstruction as well as for diagnostic reasons we decided to perform ?an explorative laparotomy. On histopathological examination the immunohistological staining was positive for myeloperoxidase (MPO) and KP-1 (CD68). Staining was slightly positive for Bcl-2, CD117, CD34, but negative for CD3, CD4, CD5, CD8, CD20, CD30, CD79, Bcl-6 and S-100. This leads to the diagnosis of a myeloid sarcoma. After recovery from surgery and chemotherapy, allogenic bone marrow transplantation was performed. Most intestinal obstructions are caused by postoperative adhesions or hernias and only in rare cases caused by a myeloid sarcoma.

关键词： Myeloid Sarcoma Small Bowel Obstruction

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肝细胞肝癌肝移植的预后因素分析

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同济大学学报（医学版） 2014年第1期35卷 52-57页

作者：赵泽明 Thomas Becker 范跃祖 Bastian Ringe jürgen klempnauer 同济大学附属同济医院普外科汉诺威医科大学内脏移植外科基尔大学医院内脏移植外科

目的评价肝细胞肝癌(hepatocellular carcinoma,HCC)原位肝移植后的预后相关因素。方法回顾性分析1993年11月到2006年5月期间汉诺威医科大学对117例HCC进行肝移植的经验。结果经多因素分析,肿瘤大小和肿瘤数量(米兰标准或加州标准)、微... 详细信息

目的评价肝细胞肝癌(hepatocellular carcinoma,HCC)原位肝移植后的预后相关因素。方法回顾性分析1993年11月到2006年5月期间汉诺威医科大学对117例HCC进行肝移植的经验。结果经多因素分析,肿瘤大小和肿瘤数量(米兰标准或加州标准)、微血管侵犯、移植前治疗和肿瘤复发是影响患者生存预后的重要因素。结论原位肝移植是治疗HCC的理性术式;合适的选择标准,积极的移植前治疗,复发的有效控制,是患者获得良好预后的关键。

关键词：肝细胞肝肿瘤肝移植预后

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Mapping of liver-enriched transcription factors in the human intestine

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World journal of Gastroenterology 2010年第31期16卷 3919-3927页

作者： Frank Lehner Ulf Kulik juergen klempnauer juergen Borlak Department of General Visceral and Transplantation SurgeryHanover Medical School Molecular Medicine and Medical Biotechnol-ogy Fraunhofer Institute of Toxicology and Experimental Medi-cine Center of Pharmacology and Toxicology Hanover Medical School

AIM: To investigate the gene expression pattern of hepatocyte nuclear factor 6 (HNF6) and other liverenriched transcription factors in various segments of the human intestine to better understand the differentiation of the gut epithelium. METHODS: Samples of healthy duodenum and jejunum were obtained from patients with pancreatic cancer whereas ileum and colon was obtained from patients undergoing right or left hemicolectomy or (recto)sigmoid or rectal resection. All surgical specimens were subjected to histopathology. Excised tissue was shock-frozen and analyzed for gene expression of liver-enriched transcription factors by semiquantitative reverse transcription polymerase chain and compared to the human colon carcinoma cell line Caco-2. Protein expression of major liver-enriched transcription factors was determined by Western blotting while the DNA binding of HNF6 was investigated by electromobility shift assays. RESULTS: The gene expression patterning of liverenriched transcription factors differed in the various segments of the human intestine with HNF6 gene expression being most abundant in the duodenum (P jejunum (P jejunum (P jejunum and less in the ileum. The expression of HNF6 and of genes targeted by this factor, i.e. neurogenin 3 (NGN3) was most abundant in the jejunum followed by the ileum and the colon while DNA binding activity of HNF4α and of NGN3 was conf irmed by electromobility shift assays to an optimized probe. Furthermore, Western blotting provided evidence of the expression of several liver-enriched transcription factors in cultures of colon epithelial cells, albeit at

关键词： Liver-enriched transcription factors Human intestine Caco-2 Gene expression

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Changes of duplex parameters and splenic size in liver transplant recipients during a long period of observation

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World journal of Gastroenterology 2005年第43期11卷 6787-6791页

作者： Bita Boozari Michael Gebel Mathias j Bahr Michael P Manns Christian P Strassburg joerg S Bleck j klempnauer Bjoern Nashan Department of Gastroenterology Department of Visceral and Transplant Surgery Department of Transplant Surgery

AIM: To assess the changes of portal and arterial velocities, resistance index, spleen and liver size during a long observation period (13.7 years) after orthotopic liver transplantation (OLT).METHODS: Two hundred and sixty patients were recruited retrospectively for this study and divided into groups with defined time intervals after OLT. The cross-sectional changes of portal and arterial velocities,resistance index, spleen and liver size between the defined time intervals were studied. The complications detected by ultrasound were compared to gold standard ***: The mean values for liver size were all within the normal range. The splenic size decreased between the time intervals 100 and 1 000 d after OLT (t;P＜0.01).While portal and arterial flow velocities decreased up to 5.5 years (t; portal velocity P＜0.01, maximal systolic velocity P=0.05, maximal end diastolic velocity P＜0.01),RI increased during this interval (t:P＜0.01). Higher RIvalues were found in older patients (r = 0.24, P＜0.001).CONCLUSION: The arterial and portal velocities show adaptation processes continuing over the course of many years after OLT and are reported for the first time. The vascular complications detected by ultrasound occur mostly up to 100 d after OLT.

关键词： Ultrasound Color Doppler Liver transplantation Monitoring

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Ventilation after pancreaticoduodenectomy increases perioperative mortality: Identification of risk factors and their relevance in Germany that do not apply in England

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Hepatobiliary & Pancreatic Diseases International 2019年第4期18卷 379-388页

作者： Rieke-Sophie Homeyer Keith jRoberts Robert P Sutcliffe Alexander Kaltenborn Darius Mirza Zhi Qu jurgen klempnauer Harald Schrem Core Facility Quality Management Transplantation Integrated Research and Treatment Center Transplantation(IFB-Tx)Hannover Medical SchoolCarl-Neuberg-Str.130625 HannoverGermany General Visceral and Transplant SurgeryHannover Medical SchoolCarl-Neuberg-Str.130625 HannoverGermany Department of HPB Surgery Queen Elizabeth Hospital BirminghamMindelsohn Way EdgbastonBirmingham B15 2GWUnited Kingdom Department of General Visceral and Transplant SurgeryMedical University GrazAuenbrugger Platz 58036 GrazAustria

Background:Pre-operative risk factors for post-operative ventilation and their influence on survival after pancreaticoduodenectomy for malignancy are ***:Totally 391 patients operated in Hannover,Germany were investigated with multivariable logistic regression and Cox regression modeling to identify independent risk factors for post-operative ventilation≥6 h,patient survival and 90-day *** 84 patients operated in Birmingham,United Kingdom were analyzed to assess the external relevance of ***:Longer operations,history of thrombosis,intra-operative blood transfusion,lower estimated glomerular filtration rates(eGFR)and higher values of the age at operation divided by the Horovitz Quotient independently increased the risk of post-operative ventilation≥6 h in German patients(n=108;27.6%)(P75 years,had a history of thrombosis,received blood transfusions,and had significantly worse lung function ***4 tumors were detected in 18 German patients(4.6%),but not in the English ***:Identified risk factors for post-operative ventilation are clinically relevant in Germany but not in England and may be used to lower mortality *** German and the English cohorts displayed significant differences in the approach to patient selection and early post-operative extubation.

关键词： Pancreatic cancer Cholangiocellular carcinoma Periampullary carcinoma Comorbidity Outcome

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肝细胞肝癌肝移植术后复发因素分析——汉诺威经验

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中华普通外科杂志 2017年第11期32卷 901-904页

作者：赵泽明范跃祖 Becker Thomas Ringe Bastian klempnauer jtirgen 同济大学附属同济医院普外科上海200065 德国汉诺威医科大学内脏移植外科

目的探讨肝细胞肝癌（hepatocellular carcinoma，HCC）原位肝移植后的复发特性及相关影响因素。方法回顾性分析1993年11月至2006年5月汉诺威医科大学对117例合并肝硬化HCC行原位肝移植的临床资料和随访结果，应用***作术后累积存活率... 详细信息

目的探讨肝细胞肝癌（hepatocellular carcinoma，HCC）原位肝移植后的复发特性及相关影响因素。方法回顾性分析1993年11月至2006年5月汉诺威医科大学对117例合并肝硬化HCC行原位肝移植的临床资料和随访结果，应用***作术后累积存活率分析，***检验作相关临床病理因素分析。结果63例（58．3％）HCC原位肝移植患者符合米兰标准，45例（41．7％）超米兰标准，而符合和超加州大学标准分别为73例（67．6％）和35例（32．4％）；尸体供肝肝移植（cadaveric donor liver transplantation, CDLT）103例，活体供肝肝移植（living donor liver transplantation，LDLT）14例；两组术后生存率比较差异无统计学意义（P=0．911）。移植后肿瘤复发与否与患者年龄（P=0．048）、有无微血管侵犯（P=0．001）、是否超出加州标准（P=0．013）和肿瘤分化程度（P=0．015）密切相关。结论合适的选择标准、围手术期的综合治疗及复发的有效控制，是提高肝癌肝移植患者生存率的关键。

关键词：癌肝细胞肝移植活体供者

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Surgical experience in splitting donor liver into left lateral and right extended lobes

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World journal of Gastroenterology 2005年第27期11卷 4220-4224页

作者： ji-Qi Yan Thomas Becker Michael Neipp Cheng-Hong Peng Rainer Lueck Frank Lehner Hong-Wei Li juergen klempnauer Department of Surgery Ruijin Hospital Affiliated to Shanghai Second Medical University Shanghai 200025 China Department of Abdominal and Transplant Surgery Medical School of Hannover Carl-NeubergStr. 1 Hannover 30625 Germany

AIM： To outline the surgical experience with donor liver splitting in split liver ***： From March 1 to September 1 in 2004, 10 donor livers were split ex situ into a left lateral lobe （segments Ⅱ and Ⅲ） and a right extended lobe （segments Ⅰ, Ⅳ-Ⅷ） in Medical School of Hannover, and thereafter split liver transplantation was performed successfully in 29 cases. The average age, weight and ICU slaying period of the donors were 32.7 years （25-52 years）, 64.5 kg（45-75 kg） and 2.4 d （2-8 d） ***： The average weight of the whole graft and the left lateral lobe was 2 322.6 g （956-2 665 g） and 282.8 g （298-373 g） respectively, and the average ratio of left lateral lobe to the whole graft was 0.225 （0.278-0.274）.The average graft to recipient weight ratio （GRWR） of the left lateral lobe and the right extended lobe reached 2.44% （2.22-5.42%） and 2.73% （2.32-2.30%） *** average it took approximately 205 min （85-235 rain）to split the donor liver. Five donor organs showed anatomic variation including the left hepatic vein variation in two cases, the left hepatic artery variation in two cases and the bile duct variation in one ***： Split liver transplantation has become a mature surgical technique to expand the donor pool with promising results. In the process of graft splitting, close attention needs to be paid to potential anatomic variations,especially to variations of the left hepatic vein, the left hepatic artery, and the bile duct.

关键词： Split Donor liver Anatomic variation

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